Etiology and Long-term Rebleeding of Endoscopic Ulcerative Lesions in the Small Bowel in Patients with Obscure Gastrointestinal Bleeding: A Multicenter Cohort Study.
Etiology and Long-term Rebleeding of Endoscopic Ulcerative Lesions in the Small Bowel in Patients with Obscure Gastrointestinal Bleeding: A Multicenter Cohort Study.
复制标题
不明原因胃肠出血患者小肠内镜下溃疡性病变的病因学和长期再出血：一项多中心队列研究。
DOI：
10.1111/jgh.14068
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Koike K.
中科院分区：
文献类型：
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作者：
①Aoki T;Yamada A;Hirata Y;Suzuki H;Nakada A;Niikura R;Seto M;Okamoto M;Koike K.
背景：在隐蔽性胃肠道出血（OGIB）患者中，内镜下小肠溃疡病变有多种病因，并常引起再出血。患者或溃疡的某些特征可能是诊断性球囊辅助内窥镜（BAE）评估病因的合理适应症，也可能是再出血的风险；然而，这些特征尚不清楚。我们的目的是阐明诊断BAE的适当适应症和小肠溃疡性病变患者长期再出血的预测因素。方法我们对68例OGIB患者进行了一项多中心回顾性队列研究，其中60例患者通过胶囊内镜和/或BAE（43例）检测到小肠溃疡病变。评估患者的特征，包括药物和内窥镜检查结果。通过logistic回归分析确定需要诊断BAE来确定溃疡病因的预测因素。再出血风险采用Cox比例风险分析进行评估。结果单发溃疡26例，多发溃疡42例。在43例接受BAE治疗的患者中，有12例（28%）患者确定了溃疡病因。在病因鉴定方面，BAE对单发溃疡比多发溃疡更有用（P< 0.001）。在68例患者中，14例（21%）患者在平均17个月的随访期间发生再出血。阿司匹林使用和多发溃疡是再出血的显著预测因素（P< 0.05）。结论当我们处理OGIB患者的小肠溃疡病变时，单一溃疡是诊断BAE的合理指征。单发溃疡的再出血率低于多发溃疡的再出血率。
BackgroundAmong patients with obscure gastrointestinal bleeding (OGIB), endoscopic ulcerative lesions in the small bowel have diverse etiologies and often cause rebleeding. Certain characteristics of patients or ulcerations may be reasonable indications for diagnostic balloon‐assisted endoscopy (BAE) to assess etiology and may be risks of rebleeding; however, these characteristics are unclear. We aimed to elucidate appropriate indications for diagnostic BAE and predictors of long‐term rebleeding in patients with small bowel ulcerative lesions.MethodsWe conducted a multicenter retrospective cohort study of 68 patients with OGIB, in whom small bowel ulcerative lesions were detected by capsule endoscopy (n= 60) and/or BAE (n= 43). Patients' characteristics, including medications and endoscopic findings, were evaluated. Predictors of the need for diagnostic BAE to determine ulceration etiology were identified by logistic regression analysis. Rebleeding risks were evaluated using Cox proportional hazards analysis.ResultsSingle ulcerations were diagnosed in 26 patients, and multiple ulcerations were diagnosed in 42 patients. Among 43 patients who underwent BAE, ulceration etiology was identified in 12 (28%) patients. In the etiology identification, BAE was more useful for a single ulceration than for multiple ulcerations (P< 0.001). Among the 68 patients, rebleeding occurred in 14 (21%) patients during a mean follow‐up period of 17 months. Aspirin use and multiple ulcerations were significant predictors of rebleeding (P< 0.05).ConclusionsWhen we manage small bowel ulcerative lesions in OGIB patients, a single ulceration is a reasonable indication for the diagnostic BAE. The rebleeding rate was lower for single ulcerations than for multiple ulcerations.