Chak A, Koehler M K, Sundaram S N, Cooper G S, Canto M I, Sivak M V
Division of Gastroenterology, University Hospitals of Cleveland, Ohio 44106-1736, USA.
Gastrointest Endosc. 1998 Jan;47(1):18-22. doi: 10.1016/s0016-5107(98)70293-7.
Push enteroscopy is indicated in patients with suspected small bowel gastrointestinal bleeding or small bowel mucosal disease. Our aim was to determine the diagnostic yield of enteroscopy, identify clinical predictors associated with findings, and measure frequency of management changes made on the basis of results.
Endoscopy reports, office charts, and hospital charts were reviewed for 164 patients who had enteroscopy performed, primarily with a video enteroscope, during a period of 2 years. Data extraction included details of comorbid illnesses, associated risk factors, and previous endoscopies.
Indications for enteroscopy were suspected occult bleeding in 65, overt bleeding in 64, diarrhea in 20, and suspected mucosal disease in 15 patients. Diagnostic lesions, identified in 92 patients (56%), included 57 jejunal lesions (35%). In patients with overt bleeding, upper tract lesions were present more commonly in patients receiving nonsteroidal medication (54% versus 27%, p < 0.05). Jejunal vascular ectasia occurred more frequently in patients with documented vascular ectasias elsewhere in the gastrointestinal tract (34% versus 15%, p < 0.01). Missed lesions on previous upper endoscopy included large hiatal hernias with erosions in 10, peptic ulcers in 10, and vascular ectasias in 9 patients. Therapeutic interventions, made in 67 of 92 patients (73%) with diagnostic lesions, included small bowel resection in 12 (8%), endoscopic therapy in 21 (14%), and changes in medical regimen in 34 patients (22%).
Push enteroscopy with video enteroscopes has a moderate diagnostic yield. Positive findings frequently lead to therapy changes. Large hiatal hernias remain an under-recognized etiology of anemia. Repeat upper endoscopy should be considered before enteroscopy in patients taking nonsteroidals who develop overt bleeding.
推进式小肠镜检查适用于疑似小肠胃肠道出血或小肠黏膜疾病的患者。我们的目的是确定小肠镜检查的诊断率，识别与检查结果相关的临床预测因素，并衡量基于检查结果而做出的治疗方案改变的频率。
回顾了164例在2年期间接受小肠镜检查（主要使用视频小肠镜）患者的内镜检查报告、门诊病历和住院病历。数据提取包括合并疾病的详细信息、相关危险因素以及既往内镜检查情况。
小肠镜检查的适应证包括65例疑似隐匿性出血、64例显性出血、20例腹泻以及15例疑似黏膜疾病患者。92例患者（56%）发现了诊断性病变，其中包括57例空肠病变（35%）。在显性出血患者中，接受非甾体类药物治疗的患者上消化道病变更为常见（54%对27%，p<0.05）。胃肠道其他部位有血管扩张记录的患者空肠血管扩张更为常见（34%对15%，p<0.01）。既往上消化道内镜检查漏诊的病变包括10例伴有糜烂的大型食管裂孔疝、10例消化性溃疡以及9例血管扩张。92例有诊断性病变的患者中有67例（73%）接受了治疗干预，包括12例（8%）小肠切除术、21例（14%）内镜治疗以及34例（22%）患者改变药物治疗方案。
视频小肠镜推进式小肠镜检查具有中等诊断率。阳性检查结果常常导致治疗方案改变。大型食管裂孔疝仍是贫血未被充分认识的病因。对于服用非甾体类药物并发生显性出血的患者，在进行小肠镜检查前应考虑重复上消化道内镜检查。
