胶囊内镜在小肠克罗恩病诊断及病情评估中的应用价值
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摘要
克罗恩病(Crohn’s disease, CD)是一种慢性炎性肉芽肿性疾病,小肠受累多见。传统检查方法对小肠病变检出率有限,而胶囊内镜(capsule endoscopy, CE)敏感性较高,可更好地诊断和评估小肠CD。目前小肠CD的CE评分体系有胶囊内镜克罗恩病活动指数评分(capsule endoscopy Crohn’s disease activity index, CECDAI)和Lewis评分(Lewis score, LS),均为评估小肠黏膜病变的量化评估方式,不仅可提高小肠CD的诊断特异性,还可用于病情活动度评估。本文就CE在小肠CD诊断及病情评估中的应用价值作一概述。
Crohn's disease(CD) is a chronic inflammatory granulomatous disease, which most commonly affected the small bowel. Conventional modalities have a limited detection rate for small intestine lesions, while capsule endoscopy(CE) has a higher sensitivity, with which can better diagnose and evaluate small bowel CD. The capsule endoscopy Crohn's disease activity index(CECDAI) and Lewis score(LS) are quantitative evaluation methods for small intestinal mucosal lesions, which can not only improve the diagnostic specificity, but also be used for the disease activity assessment. This article reviewed the application values of CE in diagnosis and assessment of small bowel CD.
Crohn's disease(CD) is a chronic inflammatory granulomatous disease, which most commonly affected the small bowel. Conventional modalities have a limited detection rate for small intestine lesions, while capsule endoscopy(CE) has a higher sensitivity, with which can better diagnose and evaluate small bowel CD. The capsule endoscopy Crohn's disease activity index(CECDAI) and Lewis score(LS) are quantitative evaluation methods for small intestinal mucosal lesions, which can not only improve the diagnostic specificity, but also be used for the disease activity assessment. This article reviewed the application values of CE in diagnosis and assessment of small bowel CD.
引文
[1] MITSELOS I V,CHRISTODOULOU D K,KATSANOS K H,et al.The role of small bowel capsule endoscopy and ileocolonoscopy in patients with nonspecific but suggestive symptoms of Crohn’s disease [J].Eur J Gastroenterol Hepatol,2016,28(8):882-889.DOI:10.1097/MEG.0000000000000644.
[2] 常玉英,欧阳钦,胡仁伟.我国克罗恩病的漏诊误诊情况分析[J].中华消化内镜杂志,2005,22(6):372-375.DOI:10.3760/cma.j.issn.1007-5232.2005.06.003.CHANG Y Y,OUYANG Q,HU R W,et al.An analysis of misdiagnosed Crohn’s disease in China [J].Chin J Dig Endosc,2005,22(6):372-375.DOI:10.3760/cma.j.issn.1007-5232.2005.06.003.
[3] MARMO R,OTONDANO G,PISCOPO R,et al.Meta-analysis:capsule enteroscopy vs conventional modalities in diagnosis of small bowel diseases [J].Aliment Pharmacol Ther,2005,22(7):595-604.DOI:10.1111/j.1365-2036.2005.02625.x.
[4] LEIGHTON J A,GRALNEK I M,COHEN S A,et al.Capsule endoscopy is superior to small-bowel follow-through and equivalent to ileocolonoscopy in suspected Crohn’s disease [J].Clin Gastroenterol Hepatol,2014,12(4):609-615.DOI:10.1016/j.cgh.2013.09.028.
[5] LEIGHTON J A,GRALNEK I M,RICHNER R E,et al.Capsule endoscopy in suspected small bowel Crohn’s disease:economic impact of disease diagnosis and treatment [J].World J Gastroenterol,2009,15(45):5685-5692.
[6] 陆星华,秦明伟,温小恒,等.胶囊内镜、CT小肠成像、小肠造影及回结肠镜对克罗恩病诊断价值的比较[J].中华内科杂志,2010,49(9):746-749.DOI:10.3760/cma.j.issn.0578-1426.2010.09.006.LU X H,QIN M W,WEN X H,et al.The diagnosis of Crohn’s disease of the small bowel:comparing CT enterography,capsule endoscopy,small-bowel follow through and ileocolonoscopy [J].Chin J Intern Med,2010,49(9):746-749.DOI:10.3760/cma.j.issn.0578-1426.2010.09.006.
[7] DIONISIO P M,GURUDU S R,LEIGHTON J A,et al.Capsule endoscopy has a significantly higher diagnostic yield in patients with suspected and established small bowel Crohn’s disease:a meta-analysis [J].Am J Gastroenterol,2010,105(6):1240-1248.DOI:10.1038/ajg.2009.713.
[8] DESMOND A N,O’REGAN K,CURRAN C,et al.Crohn’s disease:factors associated with exposure to high levels of diagnostic radiation [J].Gut,2008,57(11):1524-1529.DOI:10.1136/gut.2008.151415.
[9] GONZáLEZ-SUáREZ B,RODRIGUEZ S,RICART E,et al.Comparison of capsule endoscopy and magnetic resonance enterography for the assessment of small bowel lesions in Crohn’s disease [J].Inflamm Bowel Dis,2018,24(4):775-780.DOI:10.1093/ibd/izx107.
[10] KOPYLOV U,YUNG D E,ENGEL T,et al.Diagnostic yield of capsule endoscopy versus magnetic resonance enterography and small bowel contrast ultrasound in the evaluation of small bowel Crohn’s disease:systematic review and meta-analysis [J].Dig Liver Dis,2017,49(8):854-863.DOI:10.1016/j.dld.2017.04.013.
[11] ROZENDORN N,KLANG E,LAHAT A,et al.Prediction of patency capsule retention in known Crohn’s disease patients by using magnetic resonance imaging [J].Gastrointest Endosc,2016,83(1):182-187.DOI:10.1016/j.gie.2015.05.048.
[12] LAHAT A,KOPYLOV U,AMITAI M M,et al.Magnetic resonance enterography or video capsule endoscopy-what do Crohn’s disease patients prefer [J].Patient Prefer Adherence,2016,10:1043-1050.DOI:10.2147/PPA.S99690.
[13] PETRUZZIELLO C,ONALI S,CALABRESE E,et al.Wireless capsule endoscopy and proximal small bowel lesions in Crohn’s disease [J].World J Gastroenterol,2010,16(26):3299-3304.
[14] BOURREILLE A,JARRY M,D’HALLUIN P N,et al.Wireless capsule endoscopy versus ileocolonoscopy for the diagnosis of postoperative recurrence of Crohn’s disease:a prospective study [J].Gut,2006,55(7):978-983.DOI:10.1136/gut.2005.081851.
[15] RAHMAN A,ROSS A,LEIGHTON J A,et al.Double-balloon enteroscopy in Crohn’s disease:findings and impact on management in a multicenter retrospective study [J].Gastrointest Endosc,2015,82(1):102-107.DOI:10.1016/j.gie.2014.12.039.
[16] PENNAZIO M,SPADA C,ELIAKIM R,et al.Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders:European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline [J].Endoscopy,2015,47(4):352-76.DOI:10.1055/s-0034-1391855.
[17] 贾燕,李世荣,王继恒,等.克罗恩病患者胶囊滞留4例临床分析并文献复习[J].胃肠病学和肝病学杂志,2018,27(5):592-595.DOI:10.3969/j.issn.1006-5709.2018.05.027.JIA Y,LI S R,WANG J H,et al.Clinical analysis of capsule retention in 4 cases of Crohn’s disease and literature reviews [J].Chin J Gastroenterol Hepatol,2018,27(5):592-595.DOI:10.3969/j.issn.1006-5709.2018.05.027.
[18] COX B F,STEWART F,LAY H,et al.Ultrasound capsule endoscopy:sounding out the future [J].Ann Transl Med,2017,5(9):201.DOI:10.21037/atm.2017.04.21.
[19] GAL E,GELLER A,FRASER G,et al.Assessment and validation of the new capsule endoscopy Crohn’s disease activity index (CECDAI) [J].Dig Dis Sci,2008,53(7):1933-1937.DOI:10.1007/s10620-007-0084-y.
[20] GOLDSTEIN J L,EISEN G M,LEWIS B,et al.Video capsule endoscopy to prospectively assess small bowel injury with celecoxib,naproxen plus omeprazole,and placebo [J].Clin Gastroenterol Hepatol,2005,3(2):133-141.
[21] ARIEIRA C,DIAS DE CASTRO F,ROSA B,et al.Can we rely on inflammatory biomarkers for the diagnosis and monitoring Crohn’s disease activity?[J].Rev Esp Enferm Dig,2017,109(12):828-833.DOI:10.17235/reed.2017.5126/2017.
[22] GRALNEK I M,DEFRANCHIS R,SEIFMAN E,et al.Development of a capsule endoscopy scoring index for small bowel mucosal inflammatory change [J].Aliment Pharmacol Ther,2008,27(2):146-154.DOI:10.1111/j.1365-2036.2007.03556.x.
[23] PONTE A,PINHO R,RODRIGUES A,et al.Evaluation and comparison of capsule endoscopy scores for assessment of inflammatory activity of small-bowel in Crohn’s disease [J].Gastroenterol Hepatol,2018,41(4):245-250.DOI:10.1016/j.gastrohep.2017.11.001.
[24] KOULAOUZIDIS A,DOUGLAS S,PLEVRIS J N.Lewis score correlates more closely with fecal calprotectin than capsule endoscopy Crohn’s disease activity index [J].Dig Dis Sci,2012,57(4):987-993.DOI:10.1007/s10620-011-1956-8.
[25] 杨黎,戈之铮,高云杰,等.CESI、简化CDAI和CRP在评估小肠克罗恩病病变范围和活动程度中的应用价值[J].胃肠病学,2012,17(4):208-211.DOI:10.3969/j.issn.1008-7125.2012.04.004.YANG L,GE Z Z,GAO Y J,et al.Use of CESI,simplified CDAI and CRP in evaluating extent of lesion and disease activity in small bowel Crohn’s disease [J].Chin J Gastroenterol,2012,17(4):208-211.DOI:10.3969/j.issn.1008-7125.2012.04.004.
[2] 常玉英,欧阳钦,胡仁伟.我国克罗恩病的漏诊误诊情况分析[J].中华消化内镜杂志,2005,22(6):372-375.DOI:10.3760/cma.j.issn.1007-5232.2005.06.003.CHANG Y Y,OUYANG Q,HU R W,et al.An analysis of misdiagnosed Crohn’s disease in China [J].Chin J Dig Endosc,2005,22(6):372-375.DOI:10.3760/cma.j.issn.1007-5232.2005.06.003.
[3] MARMO R,OTONDANO G,PISCOPO R,et al.Meta-analysis:capsule enteroscopy vs conventional modalities in diagnosis of small bowel diseases [J].Aliment Pharmacol Ther,2005,22(7):595-604.DOI:10.1111/j.1365-2036.2005.02625.x.
[4] LEIGHTON J A,GRALNEK I M,COHEN S A,et al.Capsule endoscopy is superior to small-bowel follow-through and equivalent to ileocolonoscopy in suspected Crohn’s disease [J].Clin Gastroenterol Hepatol,2014,12(4):609-615.DOI:10.1016/j.cgh.2013.09.028.
[5] LEIGHTON J A,GRALNEK I M,RICHNER R E,et al.Capsule endoscopy in suspected small bowel Crohn’s disease:economic impact of disease diagnosis and treatment [J].World J Gastroenterol,2009,15(45):5685-5692.
[6] 陆星华,秦明伟,温小恒,等.胶囊内镜、CT小肠成像、小肠造影及回结肠镜对克罗恩病诊断价值的比较[J].中华内科杂志,2010,49(9):746-749.DOI:10.3760/cma.j.issn.0578-1426.2010.09.006.LU X H,QIN M W,WEN X H,et al.The diagnosis of Crohn’s disease of the small bowel:comparing CT enterography,capsule endoscopy,small-bowel follow through and ileocolonoscopy [J].Chin J Intern Med,2010,49(9):746-749.DOI:10.3760/cma.j.issn.0578-1426.2010.09.006.
[7] DIONISIO P M,GURUDU S R,LEIGHTON J A,et al.Capsule endoscopy has a significantly higher diagnostic yield in patients with suspected and established small bowel Crohn’s disease:a meta-analysis [J].Am J Gastroenterol,2010,105(6):1240-1248.DOI:10.1038/ajg.2009.713.
[8] DESMOND A N,O’REGAN K,CURRAN C,et al.Crohn’s disease:factors associated with exposure to high levels of diagnostic radiation [J].Gut,2008,57(11):1524-1529.DOI:10.1136/gut.2008.151415.
[9] GONZáLEZ-SUáREZ B,RODRIGUEZ S,RICART E,et al.Comparison of capsule endoscopy and magnetic resonance enterography for the assessment of small bowel lesions in Crohn’s disease [J].Inflamm Bowel Dis,2018,24(4):775-780.DOI:10.1093/ibd/izx107.
[10] KOPYLOV U,YUNG D E,ENGEL T,et al.Diagnostic yield of capsule endoscopy versus magnetic resonance enterography and small bowel contrast ultrasound in the evaluation of small bowel Crohn’s disease:systematic review and meta-analysis [J].Dig Liver Dis,2017,49(8):854-863.DOI:10.1016/j.dld.2017.04.013.
[11] ROZENDORN N,KLANG E,LAHAT A,et al.Prediction of patency capsule retention in known Crohn’s disease patients by using magnetic resonance imaging [J].Gastrointest Endosc,2016,83(1):182-187.DOI:10.1016/j.gie.2015.05.048.
[12] LAHAT A,KOPYLOV U,AMITAI M M,et al.Magnetic resonance enterography or video capsule endoscopy-what do Crohn’s disease patients prefer [J].Patient Prefer Adherence,2016,10:1043-1050.DOI:10.2147/PPA.S99690.
[13] PETRUZZIELLO C,ONALI S,CALABRESE E,et al.Wireless capsule endoscopy and proximal small bowel lesions in Crohn’s disease [J].World J Gastroenterol,2010,16(26):3299-3304.
[14] BOURREILLE A,JARRY M,D’HALLUIN P N,et al.Wireless capsule endoscopy versus ileocolonoscopy for the diagnosis of postoperative recurrence of Crohn’s disease:a prospective study [J].Gut,2006,55(7):978-983.DOI:10.1136/gut.2005.081851.
[15] RAHMAN A,ROSS A,LEIGHTON J A,et al.Double-balloon enteroscopy in Crohn’s disease:findings and impact on management in a multicenter retrospective study [J].Gastrointest Endosc,2015,82(1):102-107.DOI:10.1016/j.gie.2014.12.039.
[16] PENNAZIO M,SPADA C,ELIAKIM R,et al.Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders:European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline [J].Endoscopy,2015,47(4):352-76.DOI:10.1055/s-0034-1391855.
[17] 贾燕,李世荣,王继恒,等.克罗恩病患者胶囊滞留4例临床分析并文献复习[J].胃肠病学和肝病学杂志,2018,27(5):592-595.DOI:10.3969/j.issn.1006-5709.2018.05.027.JIA Y,LI S R,WANG J H,et al.Clinical analysis of capsule retention in 4 cases of Crohn’s disease and literature reviews [J].Chin J Gastroenterol Hepatol,2018,27(5):592-595.DOI:10.3969/j.issn.1006-5709.2018.05.027.
[18] COX B F,STEWART F,LAY H,et al.Ultrasound capsule endoscopy:sounding out the future [J].Ann Transl Med,2017,5(9):201.DOI:10.21037/atm.2017.04.21.
[19] GAL E,GELLER A,FRASER G,et al.Assessment and validation of the new capsule endoscopy Crohn’s disease activity index (CECDAI) [J].Dig Dis Sci,2008,53(7):1933-1937.DOI:10.1007/s10620-007-0084-y.
[20] GOLDSTEIN J L,EISEN G M,LEWIS B,et al.Video capsule endoscopy to prospectively assess small bowel injury with celecoxib,naproxen plus omeprazole,and placebo [J].Clin Gastroenterol Hepatol,2005,3(2):133-141.
[21] ARIEIRA C,DIAS DE CASTRO F,ROSA B,et al.Can we rely on inflammatory biomarkers for the diagnosis and monitoring Crohn’s disease activity?[J].Rev Esp Enferm Dig,2017,109(12):828-833.DOI:10.17235/reed.2017.5126/2017.
[22] GRALNEK I M,DEFRANCHIS R,SEIFMAN E,et al.Development of a capsule endoscopy scoring index for small bowel mucosal inflammatory change [J].Aliment Pharmacol Ther,2008,27(2):146-154.DOI:10.1111/j.1365-2036.2007.03556.x.
[23] PONTE A,PINHO R,RODRIGUES A,et al.Evaluation and comparison of capsule endoscopy scores for assessment of inflammatory activity of small-bowel in Crohn’s disease [J].Gastroenterol Hepatol,2018,41(4):245-250.DOI:10.1016/j.gastrohep.2017.11.001.
[24] KOULAOUZIDIS A,DOUGLAS S,PLEVRIS J N.Lewis score correlates more closely with fecal calprotectin than capsule endoscopy Crohn’s disease activity index [J].Dig Dis Sci,2012,57(4):987-993.DOI:10.1007/s10620-011-1956-8.
[25] 杨黎,戈之铮,高云杰,等.CESI、简化CDAI和CRP在评估小肠克罗恩病病变范围和活动程度中的应用价值[J].胃肠病学,2012,17(4):208-211.DOI:10.3969/j.issn.1008-7125.2012.04.004.YANG L,GE Z Z,GAO Y J,et al.Use of CESI,simplified CDAI and CRP in evaluating extent of lesion and disease activity in small bowel Crohn’s disease [J].Chin J Gastroenterol,2012,17(4):208-211.DOI:10.3969/j.issn.1008-7125.2012.04.004.