Relevance of capsule endoscopy in patients with obscure gastrointestinal bleeding - a comprehensive real-world study.

IF 2 4区 医学 Q3 PHYSIOLOGY
Journal of Physiology and Pharmacology Pub Date : 2024-12-01 Epub Date: 2025-02-03 DOI:10.26402/jpp.2024.6.07
M Vetter, S Gebhardt, G Kessler, D Jesper, S Fischer, A F Hagel, J Siebler, P C Konturek, M F Neurath, S Zopf
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引用次数: 0

Abstract

Gastrointestinal bleeding is a common clinical problem. In 5% of these cases, no source of bleeding can be found by gastroscopy or colonoscopy. The aim of this study was to investigate which of these patients benefit from capsule endoscopy (CE) and how it affects subsequent management. 305 patients who underwent CE for suspected obscure gastrointestinal bleeding at two German gastroenterological centers were analysed retrospectively. All patients had previously undergone gastroscopy and colonoscopy without evidence of a sufficient source of bleeding. The PillCam SB (Medtronic) was used for CE. A source of bleeding was identified in 63.9% (195/305) of cases with CE. A source of bleeding tented to be detected more frequently by CE in patients with melena only (72.4%, p=0.002) compared to patients with hematochezia with or without melena (55.6% and 45.9%). Furthermore, early CE (day 1: 73.3%, day 2: 61.5%, day 3: 53.8%; p=0.378) and complete CE (71.1% vs. 38.8%, p=2.56*10-6) were associated with a higher detection rate. Blood was detected in 31.5% (96/305) of all CEs. However, this tended to be observed more often in patients with a high need for red blood concentrates (0 RBC: 21.4%, 1-2 RBC: 34.9%, 3-4 RBC: 38.3%, ≥5 RBC: 45.7%; p=0.026), a derailed INR (<1.15: 32.6%, 1.16-2.0: 19.5%, 2.0-3.0: 32.0%, >3: 60.0%; p=0.023) and early CE (day 1: 46.7% (7/15), day 2: 41.0% (16/39), day 3: 25.0% (13/52); p=0.244). In 12.5% of the patients a double-ballon enteroscopy (DBE) was conducted. The detection of blood during CE increased the probability for a DBE (25.0% vs. 6.7%; OR: 4.61; p=2.061*10-5). Detection of a source of hemorrhage with CE increased the likelihood of detecting a source of hemorrhage with DBE (48.1% vs. 9.1%; OR: 8.83; p=0.030). Performing a DBE did not affect the length of hospitalisation (without DBE 10d, with DBE 9.1d, p=0.81) or the number of RBCs transfused after CE (without DBE 1.9 RBC, with DBE 2.4 RBC, p=0.67). In particular, patients with melena and an increased need for RBCs could benefit from an early and complete capsule endoscopy. If a source of bleeding was detected by CE, the probability of a finding in DBE could be increased.

胶囊内镜在隐蔽性消化道出血患者中的相关性-一项全面的现实世界研究。
胃肠出血是临床上常见的问题。在5%的病例中,胃镜或结肠镜检查未发现出血来源。本研究的目的是调查哪些患者从胶囊内窥镜检查(CE)中获益,以及它如何影响后续治疗。回顾性分析了德国两家胃肠病学中心305例因疑似隐晦性消化道出血而行CE治疗的患者。所有患者之前都进行了胃镜和结肠镜检查,没有足够的出血来源的证据。使用PillCam SB (Medtronic)进行CE检测。63.9%(195/305)的CE患者有出血来源。单纯黑黑症患者(72.4%,p=0.002)比合并或不合并黑黑症的便血患者(55.6%和45.9%)更容易被CE检测出出血来源。早期CE(第1天:73.3%,第2天:61.5%,第3天:53.8%;p=0.378)和完全CE (71.1% vs. 38.8%, p=2.56*10-6)与较高的检出率相关。31.5%(96/305)的ce检出血。然而,这种情况更常见于红血球需要量高的患者(0 RBC: 21.4%, 1-2 RBC: 34.9%, 3-4 RBC: 38.3%,≥5 RBC: 45.7%;p=0.026),出轨的印度卢比(3:60.0%;p=0.023)和早期CE(第1天:46.7%(7/15),第2天:41.0%(16/39),第3天:25.0% (13/52);p = 0.244)。12.5%的患者行双气囊肠镜检查。CE期间的血液检测增加了DBE的可能性(25.0% vs. 6.7%;OR: 4.61;p = 2.061 *纯)。CE检测出血源增加了DBE检测出血源的可能性(48.1% vs. 9.1%;OR: 8.83;p = 0.030)。行DBE不影响住院时间(无DBE患者10天,DBE患者9.1天,p=0.81)或CE后输血红细胞数量(无DBE患者1.9个红细胞,DBE患者2.4个红细胞,p=0.67)。特别是黑黑症患者和对红细胞需求增加的患者可以从早期和完整的胶囊内窥镜检查中获益。如果CE检测出出血源,则发现DBE的概率可能会增加。
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来源期刊
CiteScore
4.00
自引率
22.70%
发文量
0
审稿时长
6-12 weeks
期刊介绍: Journal of Physiology and Pharmacology publishes papers which fall within the range of basic and applied physiology, pathophysiology and pharmacology. The papers should illustrate new physiological or pharmacological mechanisms at the level of the cell membrane, single cells, tissues or organs. Clinical studies, that are of fundamental importance and have a direct bearing on the pathophysiology will also be considered. Letters related to articles published in The Journal with topics of general professional interest are welcome.
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