Imaging Modalities For Diagnosis Of Small Bowel Disease:A Comparison Among Double-balloon Enteroscopy,Computed Tomographic Enterography And Capsule Endoscopy

Objective This dissertation aims to investigate the diagnosis value of double-balloon enteroscopy(DBE)for intestinal diseases,as well as the complementary values of jointly using small computed tomographic enterography(CTE)and capsule endoscopy(CE)in the diagnosis of small bowel diseases.Our results provide a scientific basis for choosing diagnosis methods for intestinal diseases in clinical.Methods A total number of 1240 cases from 894 patients visited between January 1,2008 and April 7,2016 in the digestive endoscopy center,Ruijing Hospital,were analyzed.We first collected the clinical and follow-up data.Then we analyzed these data in order to investigate the diagnostic value of DBE for small intestinal diseases by using SPSS software.Furthermore,in order to evaluate the joint diagnostic value of DBE with small intestine CTE and CE,we selected 616 cases of patients who also received CTE examinations and 167 patients who also received CE examinations.Finally,we also analyzed 109 patients who received all of the above three examinations mentioned.Based on these results,we discussed the complementary values of these three methods in small bowel disease.Results The results showed that the overall diagnostic rate for small bowel disease by using DBE is 74.7%.In particular,the main positive findings are listed in order as follows: Crohn’s disease,small bowel tumors,Meckel diverticulum and vascular malformations.The regression analysis for different clinical syndromes showed that adolescents(P<0.001)、patients with diarrhea(P<0.001),and abdominal pain(P=0.001)are more likely to be diagnosed with crohn disease.If the patients are accompanied by obscure gastrointestinal bleeding(P<0.05),then we need to consider the possibility of Meckel diverticulum and vascular malformations.If patients having these symptoms are middle-aged patients(P<0.001),then we also need to consider the possibility of small bowel tumors.By comparing these three different approaches of examinations,we found that DBE,CTE and CE do not have significant statistic differences in the diagnosis of small bowel Crohn’s disease.However,in the diagnosis of tumors,the former two have significantly higher diagnostic rates than the latter(P<0.05,κ<0.4);vice versa for the diagnosis of vascular malformation(P<0.05,κ<0.001).In addition,we found that DBE still seems to be the best way for diagnosing Meckel diverticulum.It can be used,jointly with biopsy results,as the gold standard for the diagnosis of Meckel’s diverticulum.To conclude,these three common intestinal inspection methods have complementary values,and we recommended to combine their usages to further improve that diagnostic rate for enteroscopy diseases.Conclusion DBE is a safe and reliable way for the diagnosis of small bowel disease with high diagnostic rate and few complications.Moreover,DBE,CE and CTE also have different advantages in the diagnosis of small bowel diseases.Correctly combining these techniques can improve the performance in the diagnosis of small bowel diseases.