Clinical Utility of Emergency Capsule Endoscopy for Diagnosing the Source and Nature of Ongoing Overt Obscure Gastrointestinal Bleeding
Clinical Utility of Emergency Capsule Endoscopy for Diagnosing the Source and Nature of Ongoing Overt Obscure Gastrointestinal Bleeding
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DOI：
10.1155/2019/5496242
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发表时间：
2019-12-01
影响因子：
2
通讯作者：
Chayama, Kazuaki
中科院分区：
文献类型：
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作者：
Iio, Sumio;Oka, Shiro;Chayama, Kazuaki
背景和目标。对于持续性显性不明原因消化道出血（OGIB）患者，及时发现出血源对治疗成功至关重要。然而，对于诊断性胶囊式内窥镜（CE）的最佳时机尚未达成共识。我们研究了紧急CE检测持续性明显OGIB来源的临床效用。方法.我们回顾性评价了2009年2月至2018年7月期间在广岛大学医院接受紧急CE检查的146例连续患者，以检测持续性明显OGIB的来源。排除了出血源位于小肠外的患者。其余127例患者根据CE相对于出血发作的时间进行分层：A组患者（n=15，12例男性;平均年龄：75岁;年龄范围：62-83岁）在出血发作后48小时内接受了CE检查，而B组患者（n=112，73名男性;平均年龄：65岁;年龄范围：17-88岁）在出血发作后>48小时接受CE检查。所有患者均接受双气囊内镜检查，并将最终诊断与CE结果进行比较。结果A组（12/15例患者，80%）的CE病变检出率显著高于B组（53/112例患者，47%）（p=0.0174）。两组患者的背景特征无显著差异。血管病变是两组中最常见的发现。急诊CE与双气囊内镜的诊断符合率在A组为100%，在B组为92.9%。B组仅1例患者经内镜治疗后证实再出血。结论.急诊CE是持续性明显OGIB患者的一种有用的诊断方式，可能提高检出率并降低再出血风险。
Background and Aims. In patients with ongoing overt obscure gastrointestinal bleeding (OGIB), prompt detection of the bleeding source is crucial to treatment success. However, there is no consensus on the optimal timing of diagnostic capsule endoscopy (CE). We investigated the clinical utility of emergency CE for detecting the source of ongoing overt OGIB. Methods. We retrospectively evaluated 146 consecutive patients who, between February 2009 and July 2018, underwent emergency CE at Hiroshima University Hospital to detect the source of ongoing overt OGIB. Patients with a bleeding source located outside the small bowel were excluded. The remaining 127 patients were stratified according to the timing of CE relative to the onset of bleeding: patients in group A (n=15, 12 men; mean age: 75 years; age range: 62-83 years) underwent CE within 48 hours of bleeding onset, whereas patients in group B (n=112, 73 men; mean age: 65 years; age range: 17-88 years) underwent CE at >48 hours after bleeding onset. All patients underwent double-balloon endoscopy, and the final diagnosis was compared against the CE findings. Results. The CE lesion detection rate was significantly higher in group A (12/15 patients, 80%) than in group B (53/112 patients, 47%) (p=0.0174). There was no significant difference between the two groups regarding the patients' background characteristics. Vascular lesions were the most frequent finding in both groups. The diagnostic concordance rate between emergency CE and double-balloon endoscopy was 100% in group A and 92.9% in group B. Rebleeding after endoscopic treatment was confirmed in only one patient in group B. Conclusions. Emergency CE represents a useful diagnostic modality in patients with ongoing overt OGIB, potentially improving detection rates and reducing rebleeding risk.