摘要
AIM To compare the diagnostic accuracy of video capsule endoscopy(VCE) and double-balloon enteroscopy(DBE) in cases of obscure gastrointestinal bleeding(OGIB) of vascular origin.METHODS MEDLINE(via PubMed), LILACS(via BVS) and Cochrane/CENTRAL virtual databases were searched for studies dated before 2017. We identified prospective and retrospective studies, including observational, cohort, single-blinded and multicenter studies, comparing VCE and DBE for the diagnosis of OGIB, and data of all the vascular sources of bleeding were collected. All patients were subjected to the same gold standard method. Relevant data were then extracted from each included study using a standardized extraction form. We calculated study variables(sensitivity, specificity, prevalence, positive and negative predictive values and accuracy) and performed a meta-analysis using Meta-Disc software.RESULTS In the per-patient analysis, 17 studies(1477 lesions) were included. We identified3150 exams(1722 VCE and 1428 DBE) in 2043 patients and identified 2248 sources of bleeding, 1467 of which were from vascular lesions. Of these lesions, 864(58.5%) were diagnosed by VCE, and 613(41.5%) were diagnosed by DBE. The pretest probability for bleeding of vascular origin was 54.34%. The sensitivity of DBE was 84%(95%CI: 0.82-0.86; heterogeneity: 78.00%), and the specificity was92%(95%CI: 0.89-0.94; heterogeneity: 92.0%). For DBE, the positive likelihood ratio was 11.29(95%CI: 4.83-26.40; heterogeneity: 91.6%), and the negative likelihood ratio was 0.20(95%CI: 0.15-0.27; heterogeneity: 67.3%). Performing DBE after CE increased the diagnostic yield of vascular lesion by 7%, from 83% to90%.CONCLUSION The diagnostic accuracy of detecting small bowel bleeding from a vascular source is increased with the use of an isolated video capsule endoscope compared with isolated DBE. However, concomitant use increases the detection rate of the bleeding source.
AIM To compare the diagnostic accuracy of video capsule endoscopy(VCE) and double-balloon enteroscopy(DBE) in cases of obscure gastrointestinal bleeding(OGIB) of vascular origin.METHODS MEDLINE(via PubMed), LILACS(via BVS) and Cochrane/CENTRAL virtual databases were searched for studies dated before 2017. We identified prospective and retrospective studies, including observational, cohort, single-blinded and multicenter studies, comparing VCE and DBE for the diagnosis of OGIB, and data of all the vascular sources of bleeding were collected. All patients were subjected to the same gold standard method. Relevant data were then extracted from each included study using a standardized extraction form. We calculated study variables(sensitivity, specificity, prevalence, positive and negative predictive values and accuracy) and performed a meta-analysis using Meta-Disc software.RESULTS In the per-patient analysis, 17 studies(1477 lesions) were included. We identified3150 exams(1722 VCE and 1428 DBE) in 2043 patients and identified 2248 sources of bleeding, 1467 of which were from vascular lesions. Of these lesions, 864(58.5%) were diagnosed by VCE, and 613(41.5%) were diagnosed by DBE. The pretest probability for bleeding of vascular origin was 54.34%. The sensitivity of DBE was 84%(95%CI: 0.82-0.86; heterogeneity: 78.00%), and the specificity was92%(95%CI: 0.89-0.94; heterogeneity: 92.0%). For DBE, the positive likelihood ratio was 11.29(95%CI: 4.83-26.40; heterogeneity: 91.6%), and the negative likelihood ratio was 0.20(95%CI: 0.15-0.27; heterogeneity: 67.3%). Performing DBE after CE increased the diagnostic yield of vascular lesion by 7%, from 83% to90%.CONCLUSION The diagnostic accuracy of detecting small bowel bleeding from a vascular source is increased with the use of an isolated video capsule endoscope compared with isolated DBE. However, concomitant use increases the detection rate of the bleeding source.
引文
1 Katz LB.The role of surgery in occult gastrointestinal bleeding.Semin Gastrointest Dis 1999;10:78-81[PMID:10361899]
2 Fujimori S,Seo T,Gudis K,Tanaka S,Mitsui K,Kobayashi T,Ehara A,Yonezawa M,Tatsuguchi A,Sakamoto C.Diagnosis and treatment of obscure gastrointestinal bleeding using combined capsule endoscopy and double balloon endoscopy:1-year follow-up study.Endoscopy 2007;39:1053-1058[PMID:18072055 DOI:10.1055/s-2007-967014]
3 Sulbaran M,de Moura E,Bernardo W,Morais C,Oliveira J,Bustamante-Lopez L,Sakai P,M?nkemüller K,Safatle-Ribeiro A.Overtube-assisted enteroscopy and capsule endoscopy for the diagnosis of small-bowel polyps and tumors:a systematic review and meta-analysis.Endosc Int Open 2016;4:E151-E163[PMID:26878042 DOI:10.1055/s-0041-108261]
4 Hadithi M,Heine GD,Jacobs MA,van Bodegraven AA,Mulder CJ.A prospective study comparing video capsule endoscopy with double-balloon enteroscopy in patients with obscure gastrointestinal bleeding.Am J Gastroenterol 2006;101:52-57[PMID:16405533 DOI:10.1111/j.1572-0241.2005.00346.x]
5 Foutch PG.Angiodysplasia of the gastrointestinal tract.Am J Gastroenterol 1993;88:807-818[PMID:8389094]
6 Kwo PY,Tremaine WJ.Nonsteroidal anti-inflammatory drug-induced enteropathy:case discussion and review of the literature.Mayo Clin Proc 1995;70:55-61[PMID:7808053 DOI:10.4065/70.1.55]
7 Bartram CI,Amess JA.The diagnosis of Meckel’s diverticulum by small bowel enema in the investigation of obscure intestinal bleeding.Br J Surg 1980;67:417-418[PMID:6966954 DOI:10.1002/bjs.1800670611]
8 Kodama M,Uto H,Numata M,Hori T,Murayama T,Sasaki F,Tsubouchi N,Ido A,Shimoda K,Tsubouchi H.Endoscopic characterization of the small bowel in patients with portal hypertension evaluated by double balloon endoscopy.J Gastroenterol 2008;43:589-596[PMID:18709480 DOI:10.1007/s00535-008-2198-1]
9 Safatle-Ribeiro AV,de Oliveira RJ,Pu LZ,Caiado?H,de Moura EG,Ribeiro U Jr,Zilberstein B.Obscure gastrointestinal bleeding caused by intestinal lipomatosis:double-balloon endoscopic and laparoscopic views.Endoscopy 2016;48 Suppl 1 UCTN:E61-E62[PMID:26890544 DOI:10.1055/s-0042-101387]
10 Ribeiro IB,Bernardo WM,Martins BDC,de Moura DTH,Baba ER,Josino IR,Miyahima NT,Coronel Cordero MA,Visconti TAC,Ide E.Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting:a systematic review and meta-analysis.Endosc Int Open 2018;6:E558-E567[PMID:29756013 DOI:10.1055/a-0591-2883]
11 Hermans C,Stronkhorst A,Tjhie-Wensing A,Kamphuis J,Balkom BV,Dahlmans R,Gilissen L.Double-Balloon Endoscopy in Overt and Occult Small Bowel Bleeding:Results,Complications,and Correlation with Prior Videocapsule Endoscopy in a Tertiary Referral Center.Clin Endosc2017;50:69-75[PMID:28076941 DOI:10.5946/ce.2016.079]
12 ASGE Standards of Practice Committee,Fisher L,Lee Krinsky M,Anderson MA,Appalaneni V,Banerjee S,Ben-Menachem T,Cash BD,Decker GA,Fanelli RD,Friis C,Fukami N,Harrison ME,Ikenberry SO,Jain R,Jue T,Khan K,Maple JT,Strohmeyer L,Sharaf R,Dominitz JA.The role of endoscopy in the management of obscure GI bleeding.Gastrointest Endosc 2010;72:471-479[PMID:20801285 DOI:10.1016/j.gie.2010.04.032]
13 Yano T,Yamamoto H,Sunada K,Miyata T,Iwamoto M,Hayashi Y,Arashiro M,Sugano K.Endoscopic classification of vascular lesions of the small intestine(with videos).Gastrointest Endosc 2008;67:169-172[PMID:18155439 DOI:10.1016/j.gie.2007.08.005]
14 Saurin JC,Delvaux M,Gaudin JL,Fassler I,Villarejo J,Vahedi K,Bitoun A,Canard JM,Souquet JC,Ponchon T.Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding:blinded comparison with video push-enteroscopy.Endoscopy 2003;35:576-584[PMID:12822092 DOI:10.1055/s-2003-40244]
15 Zhang Q,He Q,Liu J,Ma F,Zhi F,Bai Y.Combined use of capsule endoscopy and doubleballoon enteroscopy in the diagnosis of obscure gastrointestinal bleeding:meta-analysis and pooled analysis.Hepatogastroenterology 2013;60:1885-1891[PMID:24719922]
16 Kalra AS,Walker AJ,Benson ME,Soni A,Guda NM,Misha M,Gopal DV.Comparison of Capsule Endoscopy Findings to Subsequent Double Balloon Enteroscopy:A Dual Center Experience.Diagn Ther Endosc 2015;2015:438757[PMID:26420979 DOI:10.1155/2015/438757]
17 Chu Y,Wu S,Qian Y,Wang Q,Li J,Tang Y,Bai T,Wang L.Complimentary Imaging Modalities for Investigating Obscure Gastrointestinal Bleeding:Capsule Endoscopy,Double-Balloon Enteroscopy,and Computed Tomographic Enterography.Gastroenterol Res Pract 2016;2016:8367519[PMID:26858753 DOI:10.1155/2016/8367519]
18 Ribeiro IB,Rezende DT,Madruga Neto AC,Ide E,Furuya CK,De Moura DTH,De Moura EGH.Endoscopic dual therapy for giant peptic ulcer hemorrhage.Endoscopy 2018[PMID:30107634DOI:10.1055/a-0665-4142]
19 Shiani A,Nieves J,Lipka S,Patel B,Kumar A,Brady P.Degree of concordance between single balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding after an initial positive capsule endoscopy finding.Therap Adv Gastroenterol 2016;9:13-18[PMID:26770263 DOI:10.1177/1756283X15610042]
20 Carey EJ,Fleischer DE.Investigation of the small bowel in gastrointestinal bleeding--enteroscopy and capsule endoscopy.Gastroenterol Clin North Am 2005;34:719-734[PMID:16303579 DOI:10.1016/j.gtc.2005.08.009]
21 Gerson LB,Van Dam J.Wireless capsule endoscopy and double-balloon enteroscopy for the diagnosis of obscure gastrointestinal bleeding.Tech Vasc Interv Radiol 2004;7:130-135[PMID:16015557 DOI:10.1053/j.tvir.2004.12.004]
22 ASGE Technology Committee,Wang A,Banerjee S,Barth BA,Bhat YM,Chauhan S,Gottlieb KT,Konda V,Maple JT,Murad F,Pfau PR,Pleskow DK,Siddiqui UD,Tokar JL,Rodriguez SA.Wireless capsule endoscopy.Gastrointest Endosc 2013;78:805-815[PMID:24119509 DOI:10.1016/j.gie.2013.06.026]
23 Marmo R,Rotondano G,Casetti T,Manes G,Chilovi F,Sprujevnik T,Bianco MA,Brancaccio ML,Imbesi V,Benvenuti S.Degree of concordance between double-balloon enteroscopy and capsule endoscopy in obscure gastrointestinal bleeding:a multicenter study.Endoscopy 2009;41:587-592[PMID:19588285 DOI:10.1055/s-0029-1214896]
24 Pennazio M,Spada C,Eliakim R,Keuchel M,May A,Mulder CJ,Rondonotti E,Adler SN,Albert J,Baltes P.Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders:European Society of Gastrointestinal Endoscopy(ESGE)Clinical Guideline.Endoscopy 2015;47:352-376[PMID:25826168 DOI:10.1055/s-0034-1391855]
25 Martínez EP,Robles EP.Capsule endoscopy and deep enteroscopy.Endoscopy 2014;46:787-790[PMID:25133478 DOI:10.1055/s-0034-1377448]
26 Westerhof J,Weersma RK,Koornstra JJ.Investigating obscure gastrointestinal bleeding:capsule endoscopy or double balloon enteroscopy?Neth J Med 2009;67:260-265[PMID:19687519]
27 Kameda N,Higuchi K,Shiba M,Machida H,Okazaki H,Yamagami H,Tanigawa T,Watanabe K,Watanabe T,Tominaga K.A prospective,single-blind trial comparing wireless capsule endoscopy and double-balloon enteroscopy in patients with obscure gastrointestinal bleeding.JGastroenterol 2008;43:434-440[PMID:18600387 DOI:10.1007/s00535-008-2182-9]
28 Otsuka T,Kawazoe S,Nakashita S,Kamachi S,Oeda S,Sumida C,Akiyama T,Ario K,Fujimoto M,Tabuchi M.Low-dose rectal diclofenac for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis:a randomized controlled trial.J Gastroenterol 2012;47:912-917[PMID:22350703 DOI:10.1007/s00535-012-0554-7]
29 Nakamura M,Niwa Y,Ohmiya N,Miyahara R,Ohashi A,Itoh A,Hirooka Y,Goto H.Preliminary comparison of capsule endoscopy and double-balloon enteroscopy in patients with suspected small-bowel bleeding.Endoscopy 2006;38:59-66[PMID:16429356 DOI:10.1055/s-2005-870446]
30 Kamalaporn P,Cho S,Basset N,Cirocco M,May G,Kortan P,Kandel G,Marcon N.Doubleballoon enteroscopy following capsule endoscopy in the management of obscure gastrointestinal bleeding:outcome of a combined approach.Can J Gastroenterol 2008;22:491-495[PMID:18478135]
31 ASGE Standards of Practice Committee,Gurudu SR,Bruining DH,Acosta RD,Eloubeidi MA,Faulx AL,Khashab MA,Kothari S,Lightdale JR,Muthusamy VR,Yang J,DeWitt JM.The role of endoscopy in the management of suspected small-bowel bleeding.Gastrointest Endosc 2017;85:22-31[PMID:27374798 DOI:10.1016/j.gie.2016.06.013]
32 Maeda Y,Moribata K,Deguchi H,Inoue I,Maekita T,Iguchi M,Tamai H,Kato J,Ichinose M.Video capsule endoscopy as the initial examination for overt obscure gastrointestinal bleeding can efficiently identify patients who require double-balloon enteroscopy.BMC Gastroenterol 2015;15:132[PMID:26467439 DOI:10.1186/s12876-015-0362-7]
33 Rahmi G,Samaha E,Vahedi K,Delvaux M,Gay G,Lamouliatte H,Filoche B,Saurin JC,Ponchon T,Rhun ML.Long-term follow-up of patients undergoing capsule and double-balloon enteroscopy for identification and treatment of small-bowel vascular lesions:a prospective,multicenter study.Endoscopy 2014;46:591-597[PMID:24830401 DOI:10.1055/s-0034-1365514]
34 Kaffes AJ,Siah C,Koo JH.Clinical outcomes after double-balloon enteroscopy in patients with obscure GI bleeding and a positive capsule endoscopy.Gastrointest Endosc 2007;66:304-309[PMID:17643704 DOI:10.1016/j.gie.2007.02.044]
35 Li X,Dai J,Lu H,Gao Y,Chen H,Ge Z.A prospective study on evaluating the diagnostic yield of video capsule endoscopy followed by directed double-balloon enteroscopy in patients with obscure gastrointestinal bleeding.Dig Dis Sci 2010;55:1704-1710[PMID:19672712 DOI:10.1007/s10620-009-0911-4]
36 Moher D,Liberati A,Tetzlaff J,Altman DG.Preferred Reporting Items for Systematic Reviews and Meta-Analyses:The PRISMA Statement Ann Intern Med 2014;151:264-269.[DOI:10.1371/journal.pmed.1000097]
37 Holleran G,Hall B,Alhinai M,Zaheer A,Leen R,Alakkari A,Mahmud N,McNamara D.Double-balloon enteroscopy in Ireland in the capsule endoscopy era.Ir J Med Sci 2015;184:257-262[PMID:24633527 DOI:10.1007/s11845-014-1097-0]
38 Fuller NR,Pearson S,Lau NS,Wlodarczyk J,Halstead MB,Tee HP,Chettiar R,Kaffes AJ.An intragastric balloon in the treatment of obese individuals with metabolic syndrome:a randomized controlled study.Obesity(Silver Spring)2013;21:1561-1570[PMID:23512773 DOI:10.1002/oby.20414]
39 Tian Min C,Li Hua X,Ying Lin J,Yan Mei Y,Fei L,Jun Bo Q.The role of double-balloon enteroscopy following capsule endoscopy in diagnosis of obscure Small intestinal diseases.Pak JMed Sci 2013;29:479-484[PMID:24353560]
40 Lin TN,Su MY,Hsu CM,Lin WP,Chiu CT,Chen PC.Combined use of capsule endoscopy and double-balloon enteroscopy in patients with obscure gastrointestinal bleeding.Chang Gung Med J2008;31:450-456[PMID:19097591]
