| 摘要: |
| 目的 评估气囊辅助小肠镜（BAE）对狭窄型小肠克罗恩病（CD）与其他非感染性良性小肠狭窄的鉴别诊断价值。方法 回顾性分析空军特色医学中心2014年10月至2021年6月收治的67例良性小肠狭窄患者的临床资料，对所有患者BAE检查后的诊治经过及治疗结局进行随访。通过对比基于BAE的临床诊断与最终诊断的一致性，评价BAE对狭窄型小肠CD及其他非感染性良性小肠狭窄的鉴别诊断价值，并对狭窄型小肠CD患者和其他非感染性良性小肠狭窄患者的内镜下表现进行比较。结果 67例良性小肠狭窄患者中4例失访、2例经随访纠正诊断为淋巴瘤，最终61例纳入研究。随访截至2021年10月30日，随访时间为28（4～73）个月。良性小肠狭窄的病因分别为CD（62.3%，38/61）、隐源性多灶性溃疡性狭窄性小肠炎（11.5%，7/61）、小肠结核（6.6%，4/61）、缺血性小肠炎（4.9%，3/61）、放射性小肠炎（3.3%，2/61）、非甾体抗炎药相关小肠炎（1.6%，1/61）、嗜酸性粒细胞性小肠炎（1.6%，1/61）、梅克尔憩室相关小肠狭窄（1.6%，1/61）、肠型白塞病（1.6%，1/61）和病因不明（4.9%，3/61）。基于BAE的临床诊断和最终诊断的总体一致率为80.3%（49/61）。BAE对狭窄型小肠CD诊断的灵敏度和特异度分别为97.4%和82.6%。狭窄型小肠CD患者中BAE下狭窄处出现非横行溃疡和回肠合并非狭窄性溃疡的比例均高于其他非感染性良性小肠狭窄患者［53.1%（17/32） vs 16.7%（3/18）、38.9%（14/36） vs 0，P均<0.05］，两组患者在镜下小肠狭窄的部位、程度、形态及是否存在纤维性狭窄、是否存在多发狭窄方面差异均无统计学意义（P均>0.05）。结论 BAE对狭窄型小肠CD与其他非感染性良性小肠狭窄有较高的鉴别诊断价值，但仍需要结合临床表现、其他检查手段和长期随访综合判断。 |
| 关键词: 气囊辅助小肠镜 良性小肠狭窄 克罗恩病 隐源性多灶性溃疡性狭窄性小肠炎 |
| DOI：10.16781/j.CN31-2187/R.20211154 |
| 投稿时间：2021-11-14修订日期：2022-05-08 |
| 基金项目:首都卫生发展科研专项（2020-4-5123）. |
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| Balloon-assisted enteroscopy in differential diagnosis of small bowel stenostic Crohn’s disease and other non-infectious benign small bowel stenosis |
| LIU Rong-yu1,2,LI Bai-rong1*,SUN Tao1,YIN Xin1,LI Jing1,NING Shou-bin1* |
(1. Department of Gastroenterology, Air Force Medical Center, Beijing 100142, China;
2. Department of Gastroenterology, Air Force Clinical College, Anhui Medical University, Hefei 230032, Anhui, China
*Corresponding authors) |
| Abstract: |
| Objective To evaluate the value of balloon-assisted enteroscopy (BAE) in the differential diagnosis of small bowel stenostic Crohn's disease (CD) and other non-infectious benign small bowel stenosis. Methods The clinical data of 67 patients with benign small bowel stenosis who were admitted to the Air Force Medical Center from Oct. 2014 to Jun. 2021 were retrospectively analyzed. The diagnosis and treatment process and outcomes after BAE of the included patients were followed up. Consistency between the clinical diagnosis based on BAE and final diagnosis was evaluated. The value of BAE in the differential diagnosis of small bowel stenostic CD and other non-infectious benign small bowel stenosis was evaluated, and the endoscopic performance in patients with small bowel stenostic CD and other non-infectious benign small bowel stenosis were compared. Results Among the 67 patients with benign small bowel stenosis, 4 were lost to follow-up, 2 were diagnosed as lymphoma after follow-up, and finally 61 were included in this study. The follow-up period was 28 (4-73) months until Oct. 30, 2021. The etiologies of benign small bowel stenosis were CD (62.3%, 38/61), cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) (11.5%, 7/61), small intestinal tuberculosis (6.6%, 4/61), ischemic enteritis (4.9%, 3/61), radiation enteritis (3.3%, 2/61), non-steroidal anti-inflammatory drug-related enteritis (1.6%, 1/61), eosinophilic enteritis (1.6%,1/61), Meckel's diverticulum-related small bowel stenosis (1.6%, 1/61), intestinal Behcet's disease (1.6%, 1/61), and unclear (4.9%, 3/61). The overall consistent rate between BAE-based clinical diagnosis and final diagnosis was 80.3% (49/61). The sensitivity and specificity of BAE in the diagnosis of small bowel stenostic CD were 97.4% and 82.6%, respectively. Small bowel stenostic CD patients showed more non-transverse ulcers at the stenosis and more intestinal nonstenostic ulcers in the ileum than other non-infectious benign small bowel stenosis patients (53.1%[17/32] vs 16.7%[3/18], 38.9%[14/36] vs 0; both P<0.05). No significant differences were detected in the location, degree, morphology, or the presence of fibrotic stenosis or multiple stenosis between the 2 groups (all P>0.05). Conclusion BAE has high value in the differential diagnosis of small bowel stenostic CD and other non-infectious benign small bowel stenosis, but it still needs to be combined with clinical manifestations, other examination methods, and long-term follow-up. |
| Key words: balloon-assisted enteroscopy benign small bowel stenosis Crohn’s disease cryptogenic multifocal ulcerous stenosing enteritis |
