| BackgroundThe small intestine is a tubular structure circling in the abdominal cavity.It connects the pylorus to the ileocecal valve and connects with the large intestine in the right iliac fossa.According to its anatomical position and function,it is divided into three parts:duodenum,jejunum and ileum.It is about 5～7 meters long,accounting for 70～75%of the total digestive tract.The small intestine is the main place for digestion and absorption of food,as well as endocrine and immune defense functions.Small intestinal diseases,like other organs of the digestive tract,have a wide range of diseases,mainly inflammation(bacterial,parasitic infection,etc.),tumors,stromal tumors,angiopathy,polyps,Crohn’s disease and so on.It is difficult to locate and diagnose the cause of small bowel disease because of the overlapping of small bowel tortuosity,high mobility,occult onset,poor specificity of symptoms,and lack of effective means of examination.With the development of medicine,various methods of small intestine examination have been invented and improved,mainly including small bowel enema,small bowel angiography(D SA),radionuclide scanning(ECT),computed tomography enterography(CTE),magnetic resonance enterography(MRE)and so on.With the development of CT and MR technology,CTE and MRE have gradually replaced barium enema in small intestine.MRE image quality is high,but the cost and equipment requirements are high.Examination and imaging time is so long that many patients can not tolerate;small bowel angiography can diagnose and interventional treatment of small bowel vascular disease,but can not effectively observe the intestinal mucosa and wall lesions.In recent years,with the development of endoscopy technology,the clinical application of single-balloon enteroscopy(SBE)and capsule endoscopy(CE)in small bowel examination has improved the detection rate of small bowel diseases,but the price of single-balloon enteroscopy,capsule endoscopy and traditional imaging methods has increased.The clinical value is still controversial.It is necessary to evaluate the diagnostic methods of various small bowel diseases.To this end,we conducted a retrospective study to compare the detection rate,diagnostic rate,compliance and incidence of adverse reactions of small intestinal diseases.Based on the results of the study,we discussed the effectiveness,safety and application prospects of single-balloon enteroscopy and capsule endoscopy in the diagnosis of small intestinal diseases.A practical procedure for diagnosis and treatment of small bowel diseases is available for clinical reference.AimsTo investigate the diagnostic value of single-balloon enteroscopy and capsule endoscopy in various small intestinal diseases,compare the detection rate of single-balloon enteroscopy and capsule endoscopy in small intestinal diseases,and explore the clinical significanceMethodsA retrospective analysis of patients admitted to the Department of Gastroenterology,Yantai Affiliated Hospital of Binzhou Medical University from June 2015 to June 2018 was carried out.Patients who were suspected of small bowel diseases(such as unexplained abdominal pain,abdominal distension,diarrhea,emaciation,bleeding or suspicious bleeding and so on)needed to through single-balloon enteroscopy or/and capsule endoscopy.248 cases in the SBE group,62 cases in the CE group were analyzed.The diagnostic rate and detection rate of each group were calculated.Results1.In 80 cases of single-balloon enteroscopy,55 cases(68.8%)were positive,while in 80 cases of capsule endoscopy,51 cases(63.7%)were positive.There was no significant difference between the two groups(P=0.504).2.Inflammatory diseases and neoplasm are commonly in clinic.Among the inflammatory lesions,19 cases(34.5%)were found with single-balloon enteroscopy and 19 cases(37.3%)were treated with capsule enteroscopy,P=0.771 between the two groups.3.There were more lesions in jejunum,24 cases(43.6%)with single-balloon enteroscopy and 21 cases(41.2%)with capsule endoscopy.There was no significant difference between the two groups(P=0.798>0.05).4.The adverse reactions of single-balloon endoscopy and capsule endoscopy were 26 cases(32.5%)and 9 cases(11.3%)respectively.The difference between the two groups was statistically significant(P=0.001<0.05).5.Abdominal distention/abdominal pain(9 cases,11.3%)was the main adverse reaction of single-balloon enteroscopy,nausea/vomiting(5 cases,7.5%)was the main adverse reaction of capsule endoscopy.Conclusion1.Single-balloon enteroscopy and capsule endoscopy were similar in the overall positive detection rate of small bowel diseases。2.neoplasm and inflammatory changes were the most commonly in the small bowel deseases,and the location was mainly in the jejunum3.Single-balloon enteroscopy had more adverse reactions than capsule endoscopy.4.Abdominal distention/abdominal pain was the main adverse reactions of single-balloon enteroscopy.Nausea/vomiting was the adverse reactions of capsule endoscopy.5.It suggested that capsule endoscopy should be the first choice in clinic.BackgroundObscure gastrointestinal bleeding(OGIB)is a common emergency in gastrointestinal medicine.The incidence of OGIB is about 5～10%of gastrointestinal bleeding.The most common cause is small intestinal bleeding.Because of the special anatomical structure of the small intestine,it is difficult to find the cause of the disease.With the clinical application of capsule endoscopy and enteroscopy,it has become a great leap in the diagnosis of OGIB.At present,capsule endoscopy and enteroscopy have become the first choice for diagnosis of small bowel diseases,and are the main means to find the cause of OGIB.SBE is based on the development of DBE.It has more flexible mirrors and has greater vision.In recent years,SBE has been used as an emergency means of diagnosing OGIB under general anesthesia or conscious sedation.The diagnostic rate with sedation conditions and treatment procedures is different.In addition,the patient’s response during the operation also affects the diagnosis.Previous studies have shown that the SBE diagnostic procedure has a low incidence of complications,whereas the treatment procedure may have complication as high as 8%.The complications such as perforation,bleeding,pancreatitis are commonly seen in the SBE procedures.Sedation selection may play an important role in the diagnostic value and safety of emergency SBE in OGIB.Therefore,the purpose of this study was to evaluate the diagnostic value and safety of emergency SBE for OGIB under general anesthesia or conscious sedation.AimsTo evaluate the diagnostic value and safety of emergency single-balloon enteroscopy(SBE)for obscure gastrointestinal bleeding(OGIB)under general anesthesia.MethodsData of 102 all inpatients with OGIB who were admitted from June 2015 to June 2018 and underwent SBE were retrospectively analyzed.The diagnosis and the detection rates,along with adverse events,were calculated in overall and in relation to the age and gender of patients,the type of operation and anesthesia,bleeding types(overt or occult),and SBE route(via the mouth or anus).Results1.Of 102 patients,66 positive and 11 suspected positive findings were achieved,with an overall diagnosis rate of 64.7%,and a detection rate of 75.5%.2.Ulcers(19.6%)and tumors(16.7%)were the most common causes of OGIB.3.Patients aged>60 had higher,albeit not statistically significant,diagnosis and detection rates(74.2%vs.60.6%,P=0.185;83.9%vs.71.8%,P=0.194,respectively)compared with those aged<60.4.Patient with emergency SBE had higher diagnosis rate and detection rate(68.6%vs 35.3%,P=0.023;80.0%vs 47.1%P=0.016,respectively)than those with non-emergency SBE.5.The diagnosis rate at 24 hours was higher than that at 2-7 days and one week(88.0%vs.61.5%,P=0.030;88.0%vs.53.8%,P=0.007).6.For overt bleeding,the difference in diagnosis rates at 24 hours,2-7 days,and one week was statistically significant(100.0%vs.57.1%,P=0.006;100.0%vs.57.1%,P=0.006).For occult bleeding,the pairwise comparison revealed no statistical difference.7.Patients with general anesthesia had a significant higher detection rate than those with conscious sedation(87.9%vs 63.9%,P=0.004).8.Adverse events under general anesthesia were lower,when compared to adverse events under conscious sedation(28.8%vs.69.4%,P=0.020).There was no significant difference in adverse events at the different time points(P>0.05).Conclusion1.The highest positive rate of OGIB was ulcer,followed by tumor,and the most common suspected positive lesion was nonspecific inflammation of the small intestine.2.The positive rate of SBE in patients over 60 years of age was similar to that in patients younger than 60 years old.3.The diagnostic and detection rate of emergency SBE in OGIB patients were higher than those in non-emergency SBE patients,which further illustrated the necessity of emergency SBE.4.Compared with SBE under general anesthesia and conscious sedation,the diagnostic and detection rate of OGIB patients under general anesthesia are higher.5.SBE under general anesthesia can improve the diagnostic rate of pathological changes.6.Transoral and transanal approaches have no significant effect on the diagnostic and detection rate.7.Safety under general anesthesia is consistent with conscious sedation.. |
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