气囊辅助小肠镜诊治小肠Dieulafoy病变的效果和安全性初步分析（含视频）

Analysis of the efficacy and safety of balloon‑assisted enteroscopy for the diagnosis and treatment of Dieulafoy lesions of the small intestine (with video)

摘要:

目的 评估疑似小肠出血人群中Dieulafoy病变（Dieulafoy’s lesion，DL）的发生率，并分析其临床特征、影响首次检查确诊的因素、治疗效果与安全性，以及预后情况。方法 回顾性分析2017年11月至2024年3月因疑似小肠出血就诊于空军特色医学中心消化内科，确诊为小肠DL并接受气囊辅助小肠镜（balloon‑assisted enteroscopy，BAE）治疗患者的临床资料，包括患者的临床背景、诊断及治疗细节等。结果 800例就诊者中30例（3.75%，30/800）确诊为小肠DL，其中男17例、女13例，平均年龄60.90岁。DL患者临床症状包括黑便17例（56.67%）、血便13例（43.33%），血流动力学不稳定9例（30.00%）；镜下见活动性出血23例（76.67%）。患者中21例（70.00%）存在基础疾病，10例（33.33%）长期口服抗血栓药物。19例（63.33%）患者经单次BAE检查后确诊，余11例（36.67%）患者经多次（2~4次）BAE确诊，每例确诊平均需行1.6次小肠镜检查。小肠DL最常发生在空肠。患者单次BAE治疗均成功，中位随访12.25个月（5.25~23.00个月），5例（16.67%）出现再出血，其中1例接受手术治疗。2例（6.67%）患者术后诉头晕、乏力，予对症处理后症状消失。多因素分析显示，长期口服抗血栓药物是与单次BAE确诊小肠DL相关的独立因素（OR=0.06，95%CI：0.01~0.73）。结论 小肠DL少见且易漏诊，维持服用抗血栓药物的小肠DL患者可能更容易在首次BAE检查中被确诊。病变主要位于空肠，采用包括金属夹在内的联合治疗安全性高且预后良好。

Abstract:

Objective To evaluate the incidence, clinical features, factors affecting initial diagnosis, efficacy, and safety of therapy and prognosis of small intestinal Dieulafoy lesions (DL). Methods Clinical data including clinical background, diagnosis, and treatment details of patients who were admitted to the Department of Gastroenterology, Air Force Medical Center, for suspected small bowel bleeding, diagnosed as having small bowel DL and treated with balloon-assisted enteroscopy (BAE) were retrospectively analyzed from November 2017 to March 2024. Results Among 800 patients, 30 cases (3.75%, 30/800, 17 males and 13 females) were diagnosed as having small intestine DL with the mean age of 60.90 years. Clinical symptoms included melena (56.67%, 17/30), hematochezia (43.33%, 13/30), and hemodynamic instability (30.00%, 9/30). Active bleeding occurred in 23 (76.67%) patients. Comorbidities existed in 70.00% (21/30) and 33.33% (10/30) used long-term antithrombotic agents. Diagnosis was confirmed after a single BAE in 63.33% (19/30) and after multiple BAEs (mean 1.6 procedures) in 36.67% (11/30). Lesions were predominantly located at jejunal. All patients achieved successful treatment with a single BAE procedure. The median follow-up period was 12.25 months (range: 5.25-23.00 months). Five cases (16.67%) experienced recurrent bleeding, with one case transfered to surgical intervention. Two cases (6.67%) reported post-operative symptoms of dizziness and fatigue, which resolved after symptomatic management. Multivariate analysis showed that long-term oral anticoagulant therapy (OR=0.06, 95%CI: 0.01-0.73) was an independent predictor of single-session diagnosis. Conclusion Small intestinal DL is rare and challenging to diagnose. Antithrombotic therapy may facilitate the diagnosis of DL at the first BAE. Jejunal localization is common, and combined endoscopic therapy (including clipping) is effective and safe.