| Objective: More than 90% of gastrointestinal bleeding can be checked to confirm the diagnosis by conventional gastrointestinal endoscopy(gastroscopy and colonoscopy), but there are still 5%-10% of gastrointestinal bleeding after the examination is not a clear cause, known clinically obscure gastrointestinal blooding(OGIB), of which about 75%occurred in the conventional gastrointestinal endoscopy inaccessible part of the small intestine. Double-balloon endoscope(DBE) is a more and more important new technology for clinical diagnosis and treatment in recent years, DBE application OGIB diagnosis is important for the localization and characterization. This study was designed to investigate the DBE in the diagnosis of clinical value for OGIB from multiple angles.Materials and methods: This study retrospectively analyzed from 2007 January to 2013 December in diagnosis for the clinical data of 131 cases of OGIB patients. Inclusion criteria: diagnosis in our hospital or other same level at least for a gastrointestinal endoscopy cannot clear etiology for OGIB patients, without obvious bleeding symptoms, at least a fecal occult blood test positive and(or) the decline of hemoglobin. According to the clinical symptoms and examination of the patient’s results will be divided into three groups, respectively for the hemorrhagic activity group68 cases(group A), 52 cases of previous dominant hemorrhage group(group B) and 11 patients with recessive bleeding group(group C). Statistical DBE in different diagnosis of A group, B group and C group rate, and the comparison between DBE and gastrointestinal barium meal, abdominal CT and capsule endoscopy(CE) value in the diagnosis of OGIB. Observe the tolerance and complications of DBE, check and evaluate its safety.Results: Through the analysis of the clinical data, the 131 patients of OGIB were divided into three groups: 68 cases of active overt bleeding group,52 cases of previous overt bleeding group and 11 cases of occult bleeding group, a total of 131 patients were 160 times of DBE examination, oral examination 83 times, 77 times by rectal examination, check the success rate was 98.8%(82/83) and 96.1%(74/77). DBE diagnosis rate of OGIB was82.4%(108/131). The most common type of lesions were the ulcerative lesions,tumors, vascular lesions and diverticulum lesions, lesions locate in the ileum normally. The diagnosis rate of DBE in the active hemorrhage group,previously dominant hemorrhage group and occult bleeding group was 91.2%(62/68), 75%(39/52), 63.6%(7/11), the rate of diagnosis between the three groups was statistically significant(X2=8.261, P < 0.05). The diagnosis rate of DBE in the active bleeding group compared with previous dominant hemorrhage group and occult bleeding group had statistical significance,active hemorrhage group, in the diagnosis rate was significantly higher(X2AB=5.786, P < 0.05; X2AC=6.495, P < 0.05), the diagnostic rate of DBE in the previous dominant hemorrhage group and recessive hemorrhage group showed no significant difference(X2BC=0.595, P > 0.05). 13 cases of gastrointestinal barium meal and DBE examination of patients, the barium meal diagnosis rate is 30.8%(4/13), the diagnostic rate of DBE was 76.9%(10/13), significantly higher than that in the whole gastrointestinal barium meal, both have statistical significance(X2=4.167, P < 0.05). 25 cases of OGIB patients were examined by abdominal CT and DBE successively,the diagnosis of abdominal CT rate was 20%(5/25), the diagnostic rate of DBE was 84%(21/25), significantly higher than the CT of the abdomen, both have statistical significance(X2=14.063,P < 0.05). In 23 cases of OGIB patients after CE and DBE examination, CE fault rate was 47.8%(11/23),the diagnostic rate of DBE was 69.6%(16/23), no significant difference between them, no statistical significance(X2=1.455,P > 0.05). According to the Pennazio[1]the model in the diagnostic value of CE analysis OGIB patients, and we decided to use the true positive rate and the true negative rate, false positive rate and false negative rate to evaluate the diagnostic value of DBE for OGIB. Dividing into the following four aspects: 1, the true positive rate of 99.1%, 2, true negative rate 50%, false positive rate3, 98.1%, 4, false negative rate 66.7%. A minority of patients after DBE were nausea, abdominal pain and other symptoms, without serious complications(such as acute pancreatitis, gastrointestinal perforation and bleeding). 68 patients received follow-up, follow-up of patients receiving operation, drugs and symptomatic treatment, 17 of which occurred in patients with bleeding again, the rate of rebleeding was 25%.Conclusion: 1.DBE examination is an important diagnostic method of OGIB,high rate of detection, high rate of etiological diagnosis. 2.DBE examination compared with the whole gastrointestinal barium meal and abdominal CT has a higher diagnostic rate, compared with CE had no significant difference,3.DBE can perform a biopsy and treatment under endoscope. 4.DBE is a safety inspection, the patient can be tolerated,serious complication rate is low. |
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