胶囊内镜诊断新进重庆

胶囊内镜诊断新进展（重庆）第三军医大学新桥医院消化内科赵晓晏杨歆2014-5-24当前第1页\共有45页\编于星期一\14点内镜发展史Kussmaul(德国)Hirschowitz(美国)CCDNOTES治疗内镜色素内镜细胞内镜当前第2页\共有45页\编于星期一\14点胶囊内镜发展史在胶囊内镜正式问世之前，经历了近30年的酝酿、构思和研发过程1981199820012004首次有人萌发研制无线内窥镜的设想世界上出现第一个实验用胶囊内镜雏形全球首家胶囊内镜问世中国第一个胶囊内镜在重庆诞生目前,日本、韩国也已问世当前第3页\共有45页\编于星期一\14点有效性当前第4页\共有45页\编于星期一\14点

食管病变当前第5页\共有45页\编于星期一\14点当前第6页\共有45页\编于星期一\14点当前第7页\共有45页\编于星期一\14点当前第8页\共有45页\编于星期一\14点肠道恶性淋巴瘤当前第9页\共有45页\编于星期一\14点肠道海绵状血管瘤当前第10页\共有45页\编于星期一\14点小肠腺癌当前第11页\共有45页\编于星期一\14点卵巢癌侵犯盲肠当前第12页\共有45页\编于星期一\14点

OMOM胶囊内镜临床应用初步评价作者张齐联李秀梅李红灵赵晓晏例次654016148成功率98.46%100%93.75%97.29%阳性率73.4%75%75%84.46%病种小肠炎1815543Crohn病3-31胃肠息肉79-14P-J综合征1--2血管畸形92323憩室3225蠕虫3-112小肠占位3-215胃癌-1--结肠炎/癌-1-1淋巴滤泡增生--15当前第13页\共有45页\编于星期一\14点SCI文献当前第14页\共有45页\编于星期一\14点Indicationsof

capsuleendoscopyinthefinalincludedoriginalarticlesStudytypeProcedures,rangeStudiesProcedures(patients)DetailedindicationsreportedOGIBCrohn'sdiseaseNeoplasticlesionsCeliacdiseaseClinicalsymptomsonlyOtherHealthysubjectsProspective0-30591116(1103)1086413314175578038931-50441793(1749)17931048393929710162051-100292118(2117)211815051095531522940>100173521(3493)35212454252504711754160Total(%)1498547(8462)85185420(63.6)1068(12.5)372(4.4)204(2.4)450(5.3)935(11.0)69(0.8)Retrospective0-3014254(254)254115479155018031-509405(403)40527984110283051-100231812(1809)181212841915111226472>1003211,820(11,737)11,18375259053431511604552103Total(%)7814,293(14,291)13,6549203(67.4)1227(9.0)414(3.0)177(1.3)1908(14.0)620(4.5)105(0.8)Total(%)22722,840(22,753)22,17214,623(66.0)2295(10.4)786(3.5)381(1.7)2358(10.6)1555(7.0)174(0.8)当前第15页\共有45页\编于星期一\14点Detectionrate,completeexamination,andretentionrateofcapsuleendoscopyinpatientswithdifferentindications

StudytypeSubgroupDetectionrate(%)Completionrate(%)Retentionrate(%)ProspectiveOverall58.8(55.4-62.2)84.8(82.9-86.6)1.0(0.7-1.3)OGIBsubgroup58.6(54.3-62.8)84.4(81.3-87.2)0.9(0.5-1.4)Crohn'sdiseasesubgroup58.8(51.3-66.0)89.3(82.8-94.4)2.8(1.6-4.5)Neoplasticlesionssubgroup56.5(43.5-69.0)85.6(75.8-93.2)1.8(0.5-4.0)RetrospectiveOverall60.5(55.5-65.5)81.3(78.7-83.8)1.7(1.3-2.1)OGIBsubgroup63.9(58.5-69.1)82.0(76.7-86.7)1.7(1.1-2.4)Crohn'sdiseasesubgroup45.5(30.6-60.9)74.6(69.2-79.7)2.8(3.1-7.6)Neoplasticlesionssubgroup54.9(38.2-71.1)79.1(64.1-90.9)5.7(1.8-18.3)SumOverall59.4(56.5-62.2)83.5(82.0-85.0)1.4(1.2-1.6)OGIBsubgroup60.5(57.2-63.9)83.6(80.9-86.0)1.2(0.9-1.6)Crohn'sdiseasesubgroup55.3(48.0-62.4)85.4(79.0-90.8)2.6(1.6-3.9)Neoplasticlesionssubgroup55.9(46.0-65.6)84.2(75.8-91.1)2.1(0.7-4.3)当前第16页\共有45页\编于星期一\14点DetailedclinicallysignificantfindingsbycapsuleendoscopyinthepatientswithobscureGIbleedingStudytypeProcedurerangeStudiesProcedures(patients)PositiveproceduresDetailedfindings/totalproceduresreportedAngiodysplasiaInflammation/ulcerNeoplasticlesionFreshbloodOtherProspective0-3019316(305)181167/27581481123431-5018773(730)468439/6902389339531651-10011804(804)454398/734205115352518>10081425(1425)791327/7081985936727Total(%)563318(3264)18941331/2407722(54.2)315(23.7)121(9.1)108(8.1)65(4.9)Retrospective0-30464(64)3732/4871383131-503129(129)7324/4817320251-10010843(840)577333/502136118333016>100112760(2760)17371031/18234932877943129Total(%)283796(3793)24241420/2421653(46.0)421(29.6)122(8.6)76(5.4)148(10.4)Total847114(7057)43182751/48281375(50.0)736(26.8)243(8.8)184(6.7)213(7.7)当前第17页\共有45页\编于星期一\14点胶囊内镜对小肠疾病诊断有价值当前第18页\共有45页\编于星期一\14点ResultsforcompletevisualizationofthestomachCompletevisualization,61patientsGastricareaNo.%Cardia5488.5Fundus5285.2Body5793.4Antrum5386.9Pylorus5488.5Jean-FrancoisRey

GastrointestinalEndoscopy

Volume75,Issue2,Pages373–381当前第19页\共有45页\编于星期一\14点当前第20页\共有45页\编于星期一\14点Resultsforcompletevisualizationofthestomach

GastricareaNo.%Cardia5488.5Fundus5285.2Body5793.4Antrum5386.9Pylorus5488.5Completevisualization,61patients

当前第21页\共有45页\编于星期一\14点当前第22页\共有45页\编于星期一\14点胶囊内镜机器人姿态控制系统当前第23页\共有45页\编于星期一\14点当前第24页\共有45页\编于星期一\14点BeforeAfterTimerplug乳果糖/钡剂RFIDtagUncoatedexposedwindowforfluiderosion聚对二甲苯包衣12mmPatencyCapsule

SpadaC.et.al.Anoveldiagnositctoolfordetectingfunctionalpatencyofthesmallbowel:theGivenpatencycapsule.Endoscopy2005;37;9:793-800当前第25页\共有45页\编于星期一\14点40小时后，试验囊崩解在40小时内，约80%的患者会完整的排出胶囊Capsuledisintegratesafter40hours-PatencyprovenIngestionScanning*(24-36hours)PatencyNOTproven*IfGiven®PatencyScanneriscontraindicated,usefluoroscopy试验流程SpadaC.et.al.Anoveldiagnositctoolfordetectingfunctionalpatencyofthesmallbowel:theGivenpatencycapsule.Endoscopy2005;37;9:793-800当前第26页\共有45页\编于星期一\14点当前第27页\共有45页\编于星期一\14点当前第28页\共有45页\编于星期一\14点Suturemarkerlesiondetectionratesofacolonoscope,unmodifiedMiroCamcapsuleendoscope,andSCE

144(100)2(50)3(75.0)288(100)1(12.5)8(100)366(100)2(33.3)5(83.3)477(100)2(28.5)6(85.7)Overallpolypdetectionrate(%)1003186当前第29页\共有45页\编于星期一\14点OMOMpH食道无线监测系统当前第30页\共有45页\编于星期一\14点胶囊内镜检查并发症胶囊滞留 1-5%肠梗阻 0.5%胶囊穿透 罕见胶囊误吸 罕见当前第31页\共有45页\编于星期一\14点Factors/lesionsresponsiblefororassociatedwith

capsuleretention

Reasons(diseases)Prospectivestudies,no.(%)Retrospectivestudies,no.(%)Total,no.(%)Total39145184Notreported153348Reported24112136Crohn'sdisease6(25.0)42(37.5)48(35.3)Neoplasticlesions9(37.5)21(18.8)30(22.1)NSAID-inducedenteropathy2(8.3)23(20.5)25(18.4)Postsurgicalstenosis2(8.3)8(7.1)10(7.4)Intestinaladhesion0(0)4(3.6)4(2.9)Tuberculosis0(0)3(2.7)3(2.2)Ischemia-inducedstenosis0(0)2(1.8)2(1.5)Radiationenteritis1(4.2)2(1.8)3(2.2)Meckel'sdiverticulum1(4.2)1(0.9)2(1.5)Pouch1(4.2)1(0.9)2(1.5)Pepticulcerscarwithstricture0(0)1(0.9)2(0.7)Cryptogenicmultifocalulcerousstenosingenteritis0(0)1(0.9)1(0.7)Ulceration2(8.3)3(2.7)5(3.7)GastrointestinalEndoscopy

Volume71,2010

当前第32页\共有45页\编于星期一\14点胶囊内镜的滞留滞留的定义：胶囊内镜在消化道内停留的时间超过2周，需要药物，小肠镜或者手术解除滞留约58.7%的胶囊内镜滞留患者需要外科手术当前第33页\共有45页\编于星期一\14点Whatisalreadyknownonthistopic

Video

retentioninthesmallbowelmayoccurin1.4%to13%ofcases.Whatthisstudyaddstoourknowledge

Inaretrospectivestudyof904studies,8patientsretainedthevideoweresuccessfullyremovedbyusingdouble-balloon

当前第34页\共有45页\编于星期一\14点当前第35页\共有45页\编于星期一\14点胶囊嵌顿并穿透当前第36页\共有45页\编于星期一\14点在严重脊柱侧弯的患者中，胶囊内镜卡在了支气管中当前第37页\共有45页\编于星期一\14点发生胶囊内镜误吸的风险急性卒中/脑血管疾病史神经系统疾病重症肌无力

帕金森氏症