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腾讯登录AJG：胶囊内镜具有诊断优势
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7月24日，在线发表在《美国胃肠病学杂志》（<em>American Journal of Gastroenterology</em>）的一篇研究显示，与血管造影相比，胶囊内镜对不明原因的显性胃肠出血患者的诊断率较高，并且长时间转归相当。
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“由于胶囊内镜没有即时治疗的可能，因此大多数指南支持用血管造影诊断活动性显性不明原因胃肠出血”。来自香港中文大学的Wai K. Leung博士说。“目前这项前瞻性随机研究的结果为支持即时胶囊内镜在诊断显性不明原因胃肠出血中的作用提供了证据。”
Leung博士和其同事将60例显性不明原因胃肠出血患者随机分配接受胶囊内镜或血管造影检查。其中胶囊内镜组（16/30例患者，53.3%）的诊断率显著高于血管造影组（6/30例患者，20%，P=0.016）。在中位随访48.5个月期间，胶囊内镜或血管造影后的累计出血率无显著差异（16.7%对33.3%，P=0.23），住院率和输血率亦无显著差异。8例患者在随访期间死亡（每组4例）。死亡均与出血无关。
“我们的数据支持了如下观点：胶囊内镜可能优于血管造影，即使它无法改善临床疗效，因为它创伤性较小，可避免放射暴露，并且长期转归和血管造影相当。”研究人员总结道。
“对于大出血患者亚组，血管造影由于存在治疗性栓塞控制出血的可能性，可能仍具有优势。此外，在活动性出血时血管造影的诊断率升高。” Leung博士说。“与显性不明原因胃肠出血相关的其他重要且未解决的问题包括球囊辅助小肠镜的位置和检查时机。我们下一项重要的研究是比较直接胶囊内镜和直接小肠镜对显性不明原因胃肠出血患者的诊断率和转归。”
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<img src="http://www.bioon.com/biology/UploadFiles/201208/2012081822535766.jpg" alt="" width="113" height="149" border="0" hspace="0" />
<a title="" href="http://dx.doi.org/10.1038/ajg.2012.212" target="_blank">doi:10.1038/ajg.2012.212</a>
PMC:
PMID:
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<br/><strong>Capsule Endoscopy or Angiography in Patients With Acute Overt Obscure Gastrointestinal Bleeding: A Prospective Randomized Study With Long-Term Follow-Up</strong><br/>
Wai K Leung, Simon S M Ho, Bing-Yee Suen, Larry H Lai, Simon Yu, Enders K W Ng, Simon S M Ng, Philip W Y Chiu, Joseph J Y Sung, Francis K L Chan and James Y W Lau
AbstractOBJECTIVES:
Both capsule endoscopy (CE) and angiography have been recommended as first investigation for patients with acute overt obscure gastrointestinal bleeding (OGIB). However, no studies have directly compared the two modalities in patients with overt OGIB. We compared the diagnostic yield and long-term outcomes of patients with overt OGIB randomized to CE or angiogram.
METHODS:
Consecutive patients presented with acute melena or hematochezia, but nondiagnostic upper and lower endoscopy, were immediately randomized to receive small-bowel CE or angiography. All patients were monitored for rebleeding and anemia for up to 5 years. Primary end point was the diagnostic yield of the assigned investigation. Secondary end points included rebleeding, further transfusion, readmission for bleeding or anemia, and mortality.
RESULTS:
A total of 60 patients with overt OGIB were randomized. The mean follow-up was 48.5 months. The diagnostic yield of immediate CE was significantly higher than angiography (53.3% vs. 20.0%, P=0.016). The cumulative risk of rebleeding in the angiography and CE group was 33.3% and 16.7%, respectively (P=0.10, log-rank test). There was no significant difference in the long-term outcomes between the two groups including further transfusion, hospitalization for rebleeding, and mortality.
CONCLUSIONS:
In patients with overt OGIB, immediate CE has higher diagnostic yield and comparable long-term outcomes when compared with angiography.
<br/>来源：医脉通
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7月24日，在线发表在《美国胃肠病学杂志》（<em>American Journal of Gastroenterology</em>）的一篇研究显示，与血管造影相比，胶囊内镜对不明原因的显性胃肠出血患者的诊断率较高，并且长时间转归相当。
<!--more-->
“由于胶囊内镜没有即时治疗的可能，因此大多数指南支持用血管造影诊断活动性显性不明原因胃肠出血”。来自香港中文大学的Wai K. Leung博士说。“目前这项前瞻性随机研究的结果为支持即时胶囊内镜在诊断显性不明原因胃肠出血中的作用提供了证据。”
Leung博士和其同事将60例显性不明原因胃肠出血患者随机分配接受胶囊内镜或血管造影检查。其中胶囊内镜组（16/30例患者，53.3%）的诊断率显著高于血管造影组（6/30例患者，20%，P=0.016）。在中位随访48.5个月期间，胶囊内镜或血管造影后的累计出血率无显著差异（16.7%对33.3%，P=0.23），住院率和输血率亦无显著差异。8例患者在随访期间死亡（每组4例）。死亡均与出血无关。
“我们的数据支持了如下观点：胶囊内镜可能优于血管造影，即使它无法改善临床疗效，因为它创伤性较小，可避免放射暴露，并且长期转归和血管造影相当。”研究人员总结道。
“对于大出血患者亚组，血管造影由于存在治疗性栓塞控制出血的可能性，可能仍具有优势。此外，在活动性出血时血管造影的诊断率升高。” Leung博士说。“与显性不明原因胃肠出血相关的其他重要且未解决的问题包括球囊辅助小肠镜的位置和检查时机。我们下一项重要的研究是比较直接胶囊内镜和直接小肠镜对显性不明原因胃肠出血患者的诊断率和转归。”
<div id="ztload">
<div>
<div>
<img src="http://www.bioon.com/biology/UploadFiles/201208/2012081822535766.jpg" alt="" width="113" height="149" border="0" hspace="0" />
<a title="" href="http://dx.doi.org/10.1038/ajg.2012.212" target="_blank">doi:10.1038/ajg.2012.212</a>
PMC:
PMID:
</div>
<div>
<br/><strong>Capsule Endoscopy or Angiography in Patients With Acute Overt Obscure Gastrointestinal Bleeding: A Prospective Randomized Study With Long-Term Follow-Up</strong><br/>
Wai K Leung, Simon S M Ho, Bing-Yee Suen, Larry H Lai, Simon Yu, Enders K W Ng, Simon S M Ng, Philip W Y Chiu, Joseph J Y Sung, Francis K L Chan and James Y W Lau
AbstractOBJECTIVES:
Both capsule endoscopy (CE) and angiography have been recommended as first investigation for patients with acute overt obscure gastrointestinal bleeding (OGIB). However, no studies have directly compared the two modalities in patients with overt OGIB. We compared the diagnostic yield and long-term outcomes of patients with overt OGIB randomized to CE or angiogram.
METHODS:
Consecutive patients presented with acute melena or hematochezia, but nondiagnostic upper and lower endoscopy, were immediately randomized to receive small-bowel CE or angiography. All patients were monitored for rebleeding and anemia for up to 5 years. Primary end point was the diagnostic yield of the assigned investigation. Secondary end points included rebleeding, further transfusion, readmission for bleeding or anemia, and mortality.
RESULTS:
A total of 60 patients with overt OGIB were randomized. The mean follow-up was 48.5 months. The diagnostic yield of immediate CE was significantly higher than angiography (53.3% vs. 20.0%, P=0.016). The cumulative risk of rebleeding in the angiography and CE group was 33.3% and 16.7%, respectively (P=0.10, log-rank test). There was no significant difference in the long-term outcomes between the two groups including further transfusion, hospitalization for rebleeding, and mortality.
CONCLUSIONS:
In patients with overt OGIB, immediate CE has higher diagnostic yield and comparable long-term outcomes when compared with angiography.
<br/>来源：医脉通
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