床旁胶囊内镜在急重症消化道出血患者中的应用价值

Value of bedside capsule endoscopy in patients with acute or severe gastrointestinal bleeding

摘要:

目的 分析胶囊内镜在急重症消化道出血患者床旁诊断中的价值。方法 回顾性收集2018年6月至2021年9月在南方医科大学南方医院因疑诊消化道出血进行床旁胶囊内镜检查的急症及重症患者临床资料，评估胶囊内镜检查对上消化道出血及小肠出血的检查情况。结果 因疑诊急症或重症消化道出血进行床旁胶囊内镜检查的患者共74例，5例因胶囊内镜滞留胃腔导致检查失败被排除，69例纳入研究，最终明确诊断消化道出血患者54例。胶囊内镜的阳性检出率为83.33%（45/54），分别检出溃疡17例、糜烂5例、血管畸形5例、隆起型肿物4例、憩室4例、不明原因肠腔内积血5例、狭窄1例、黏膜活动性渗血1例、胃潴留1例、黏膜肿胀1例、黏膜皱襞集中改变1例。胶囊内镜诊断上消化道出血的灵敏度为92.31%（12/13），特异度为75.00%（3/4）。胶囊内镜诊断小肠出血中的灵敏度为80.49%（33/41），特异度为90.91%（10/11）。结论 胶囊内镜诊断消化道出血有较高的灵敏度和特异度，在急症及重症消化道出血患者的床旁应用中具有潜在优势。

Abstract:

Objective To analyze the diagnostic value of bedside capsule endoscopy in patients with acute or severe gastrointestinal bleeding. Methods Clinical data from patients who underwent bedside capsule endoscopy due to acute or severe suspected gastrointestinal bleeding in Nanfang Hospital, Southern Medical University from June 2018 to September 2021 were analyzed retrospectively. The efficacy of capsule endoscopy in detecting upper gastrointestinal tract and small intestinal bleeding was evaluated. Results A total of 74 patients underwent bedside capsule endoscopy for suspected acute or severe gastrointestinal bleeding. Five patients were excluded due to failure of examination due to retention of capsule endoscope in the gastric lumen, and 69 were included in the study, of whom 54 patients with a definitive diagnosis of gastrointestinal hemorrhage. The positive detection rate of the capsule endoscopy was 83.33% (45/54), including 17 cases of ulcer, 5 cases of erosion, 5 cases of vascular malformation, 4 protrusion mass, 4 diverticulum, 5 obscure gastrointestinal bleeding, 1 stenosis , 1 active mucosal blood exudation, 1 gastric retention, 1 mucosal swelling, and 1 mucosal wrinkle change. The sensitivity and specificity of capsule endoscopy in the diagnosis of upper gastrointestinal bleeding were 92.31% (12/13) and 75.00% (3/4) respectively. The sensitivity and specificity of capsule endoscopy for diagnosing small intestinal bleeding were 80.49% (33/41) and 90.91% (10/11) respectively. Conclusion Bedside capsule endoscopy demonstrates high sensitivity and specificity in the diagnosis of gastrointestinal bleeding, showing potential advantages in bedside applications for acute and severe gastrointestinal bleeding.