| Background and Objective The small bowel is the longest part of the gastrointestinal tract with the length 5～7m in adult.It is quite difficult for conventional diagnosis techniques to examine the small intestinal because of its multiple complex restricts looped configurations and its remoteness from the mouth and anus.It restricts the deep intubation of endoscopy,confines the diagnosing ability of X-ray small bowel series and influences the localization of scintigraphy and angiography. Therefore,the diagnosis of small intestinal diseases is far behind the other parts of gastrointestinal tract.And the occurrence of double-ballon enteroscopy(DBE)brings the first light of morning to the diagnosis of small intestinal disorder.Patients of suspected small intestinal diseases were performed by DBE and barium swallow or computer tomography (CT)or mesenteric agiography(MA)in our study.Analyze the diagnostic value and pathological lesions.Compare the detective yield and diagnostic yield of the three methods.Estimate the safety of DBE. Observe the patients' tolerance and complications.Estimate the clinical practicality of DBE generally.Methods We studied 168 patients who underwent DBE during July 2005 to March 2008 in the XiangYa hospital.All of the patients were performed DBE,among the total,21 cases performed CT and 18 cases performed MA.We divided suspected small intestinal disease people into groups as obscure gastrointestinal bleeding(OGIB)(96 cases),chronic abdominal pain(45cases),incomplete intestinal obstruction(15 cases),chronic diarrhea(9 cases)and rare cause hypoproteinemia(3 cases). Analyze pathological type,detective yield and diagnostic yield.Compare the detective yield and diagnostic yield of the three methods.Observe the coincidence of endoscope diagnosis and pathological diagnosis.Estimate the safety.Observe the patients' tolerance and complications.Statistical analysis was performed using the x~2 test,significance was accepted at a value of P＜0.05.Result1.96 anterograde,110 retrograde procedures.The examinational time of anterograde and retrograde was 54.17±18.28min and 73.68±23.00min, respectively.2.The totle detective yield and diagnostic yield of DBE was 82.14% (138/168)and 79.17%(133/168),respectively.Most findings are vascular malformation,then Crohn's disease,diverticulum,tumor.3.The outcomes of DBE:①Outcomes of OGIB group:the detective yield and diagnostic yield of was 93.75%(90/96)and 92.71%(89/96),respectively.Most findings are vascular malformation,then tumor,diverticulum.The detective yield and diagnostic yield of overt reactive bleeding group was 92.31%(36/39)and 89.74%(35/39),respectively.And the detective yield and diagnostic yield of repeated bleeding group was 94.73%(54/57)and 94.73%(54/57), respectively.②Outcomes of chronic abdominal pain group:the detective yield and diagnostic yield was 57.78%(26/45)and 53.33%(24/45),respectively. Main findings are Crohn's disease and tumor.③Outcomes of incomplete intestinal obstruction group:the detective yield and diagnostic yield was 73.33%(11/15)and 66.67%(10/15), respectively.Main findings are Crohn's disease and tumor.④Outcomes of chronic diarrhea group:the detective yield and diagnostic yield was 88.89%(8/9)and 77.78%(7/9),respectively.Main findings are Crohn's disease and congenital intestinal malabsorption. ⑤Outcomes of obscure hypoproteinemia group:both of the detective yield and diagnostic yield was 100.00%(3/3).Findings are Crohn's disease and congenital intestinal lymphangiectasia.4.The diagnostic yield of barium swallow was 9.88%(16/162),and DBE was 76.54%(124/162),x~2=146.706,P＜0.05.The diagnostic yield of CT and MA was 53.8%(21/39),and DBE was 76.92%(30/39), x~2=4.588,P＜0.05.The allied diagnostic yield was 82.05% (32/39),which compared to DBE,x~2 =0.315,P＞0.05;whereas, which compared to CT and MA,x~2=7.123,P＜0.05.5.The coincidence rate of endoscope diagnosis and pathological diagnosis was 87.04%(47/54).Location rate was 100.00%.6.Most of the patients could endure the examination,a part of the patients could feel nausea,slight abdominal pain and abdominal distention.We encountered 1 case of perforation digestive tract.Conclusions1.DBE is a reliable and effective examination of small bowel disease, the detective yield and diagnostic yield is high,especially the OGIB group,findings are vascular malformation,diverticulum,tumor and Crohn's disease in order;2.DBE is superior to barium swallow,CT and MA in detective yield and diagnostic yield in small bowel diseases,the allied examination can elevate detective yield;3.Concordance rate is 87.04%;4.DBE is a relatively safe examine.The incidence rate of complications was low. |
