Double-Balloon Enteroscopy in the Diagnosis and Treatment of Small Bowel Disease

對於在過去難以探查的小腸疾病，雙氣囊式小腸鏡是一個新型的診斷及治療的利器。爲評估雙氣囊式小腸鏡在小腸疾病診斷及治療上的運用，我們收集了民國96年4月1日起至民國99年3月31日接受雙氣囊式小腸鏡檢查的病人（共68位，男42例，女26例），這些病人大多接受過上消化道內視鏡與大腸鏡的檢查但仍無法查出病因。這68位病人共接受了93次雙氣囊式小腸鏡檢查，有63次經口腔端而30次經肛門端。平均所需的檢查時間為77.2±34.6分鐘。隱晦性胃腸道出血是最常見的適應症，佔86.8%(59/68)。其中36位(55.9%)接受小腸鏡檢查後找出小腸病灶，27位接受了內視鏡治療，8位接受了外科手術，還有1位接受了內視鏡治療併外科手術，其中31位(86.1%)在治療之後明顯止血。末期腎病的病人比起非末期腎病的病人在雙氣囊式小腸鏡的診斷上有較高的血管分化不良的發生率（33.3%對10.0%, P=0.031），確實的原因目前仍不清楚。沒有病人發生併發症或死亡情形。文獻中提及的病發症很少，最常見的是急性胰臟炎，出血、腸穿孔等等。如果在小腸鏡診療後病人有腹痛情況，首先考慮急性胰臟炎，需立即診斷與處理。經口腔端的小腸鏡比經肛門端小腸鏡的有較高的診斷率（68.3%對33.3%, P=0.006），及較短的操作時間。（69.2±29.1對95.9±34.8分鐘，P=0.001）。本研究顯示，雙氣囊式小腸鏡是檢查小腸病灶的有效方法，特別對於隱晦性胃腸道出血能有良好的診斷及安全的止血效果。而經口腔端的小腸鏡檢查比經肛門端小腸鏡檢查的有較高的診斷率，及較短的操作時間。

關鍵字

雙氣囊式小腸鏡；小腸疾病

並列摘要

Background: Double-balloon enteroscopy (DBE) is a novel technique which has been used for investigation and treatment of previously inaccessible lesions in the small intestine. Methods: We retrospectively reviewed the medical records of patients who received DBE for suspicious small bowel disease from April 2007 to March 2010 in our hospital. Most patients had undergone at least one esophagogastroduodenoscopy and colonscopy. The clinical decision of starting DBE from oral or anal approach was based on the patients' primary clinical presentation. Data were retrospectively collected in respect of clinical and endoscopic findings, treatment outcome and complications. We analyzed DBE investigation time, and compared diagnosis rate and wasting time of oral route and anal route. Results: Diagnostic yield in all DBE examinations was obtained in 40 of the 68 patients (58.8%). DBE resulted in a therapeutic intervention (endoscopic or surgical) in 52.9% of the patients (36 in 68 patients) and good hemostasis rate in the subgroup of obscure gastrointestinal bleeding 86.1% (31 in 36 patients who had bleeder found). Small bowel angiodysplasia had a higher incidence in end stage renal disease (ESRD) patients than in non-ESRD patients (33.3% vs. 10.0%, P=0.031). No complication was observed. The DBE diagnostic rate was higher via oral route than those via anal route. (68.3% vs. 33.3%; P=0.006). The overall procedural time for DBE was 77.2±34.6 min. DBE spent less procedure time via oral route than those via anal route. (69.2±29.1 min vs. 95.9±34.8 min; P=0.001). Conclusions: DBE is a clinically useful method to diagnose small bowel disease. Moreover, hemostatic intervention by DBE is safe and effective in small bowel bleeding. Small bowel angiodysplasia had a higher incidence in ESRD patients than in non-ESRD patients. DBE via oral route may take less procedure time with higher diagnostic yield rate than that via anal route.

並列關鍵字

double balloon enteroscopy ； small bowel disease

國際替代計量

Double-Balloon Enteroscopy in the Diagnosis and Treatment of Small Bowel Disease

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