胶囊内镜与双气囊小肠镜诊断不明原因消化系出血的Meta分析

Diagnosis and Management of Non-Variceal Gastrointestinal Hemorrhage: A Review of Current Guidelines and Future Perspectives

Non-variceal gastrointestinal bleeding (GIB) is a significant cause of mortality and morbidity worldwide which is encountered in the ambulatory and hospital settings. Hemorrhage form the gastrointestinal (GI) tract is categorized as upper GIB, small bowel bleeding (also formerly referred to as obscure GIB) or lower GIB. Although the etiologies of GIB are variable, a strong, consistent risk factor is use of non-steroidal anti-inflammatory drugs. Advances in the endoscopic diagnosis and treatment of GIB have led to improved outcomes. We present an updated review of the current practices regarding the diagnosis and management of non-variceal GIB, and possible future directions.

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.

Clinical application of a self-made capsule endoscope pusher

AIM: To observe the clinical effects of a self-made capsule endoscope pusher, in order to solve the problem of gastric retention of capsule endoscope.

METHODS: Forty selective patients with gastric retention of capsule endoscope were divided into two groups (n = 20 for each): an observation group and a control group. In the observation group, the pusher was mounted to the duodenoscope front to push the capsule endoscope into the duodenum, and the capsule endoscopy was then released into the duodenum using biopsy forceps. In the control group, a snare trap was used to push the capsule endoscope into the duodenum for release.

RESULTS: In the observation group, all endoscopes were pushed through the pylorus into the duodenum, with a success rate of 100%. The success rate in the control group was 40%. In the observation group, the success rate and the compliance of patients were significantly higher than those in the control group (P < 0.01). The total operative time and the running time were not statistically significant between the two groups (P > 0.05).

CONCLUSION: The capsule endoscope pusher is simple and practical, with a higher success rate, less adverse reactions, and better compliance. It solves the problem of gastric retention of capsule endoscope; however, it has disadvantage of invasiveness, pain, and increased costs.