胶囊内镜诊断新进重庆

1、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第一页，共四十五页。内镜发展史Kussmaul(德国)Hirschowitz(美国)CCDNOTES治疗内镜色素内镜细胞内镜第二页，共四十五页。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 1981 1998 2001 2004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、韩国也已问世第三页，共四十五页。有效性第四页，共四十五页。 食管病变第五页，共四十五页。第六页，共四十五页。第七页，共四十五页。第八

2、页，共四十五页。肠道恶性淋巴瘤第九页，共四十五页。肠道海绵状血管瘤第十页，共四十五页。小肠腺癌第十一页，共四十五页。卵巢癌侵犯盲肠第十二页，共四十五页。 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第十三页，共四十五页。SCI文献第十四页，共四十五页。Indications of c

3、apsule endoscopy in the final included original articles Study typeProcedures, rangeStudiesProcedures (patients)Detailed indications reportedOGIBCrohns diseaseNeoplastic lesionsCeliac diseaseClinical symptoms onlyOtherHealthy subjectsProspective0-30591116 (1103)1086413314175578038931-50441793 (1749)

4、17931048393929710162051-100292118 (2117)211815051095531522940100173521 (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)1812128419151

5、112264721003211,820 (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)第十五页，共四十五页。Detection rate, complete ex

6、amination, and retention rate of capsule endoscopyin patients with different indications Study typeSubgroupDetection rate (%)Completion rate (%)Retention rate (%)ProspectiveOverall58.8 (55.4-62.2)84.8 (82.9-86.6)1.0 (0.7-1.3)OGIB subgroup58.6 (54.3-62.8)84.4 (81.3-87.2)0.9 (0.5-1.4)Crohns disease su

7、bgroup58.8 (51.3-66.0)89.3 (82.8-94.4)2.8 (1.6-4.5)Neoplastic lesions subgroup56.5 (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)OGIB subgroup63.9 (58.5-69.1)82.0 (76.7-86.7)1.7 (1.1-2.4)Crohns disease subgroup45.5 (30.6-60.9)74.6 (69.2-79.7

8、)2.8 (3.1-7.6)Neoplastic lesions subgroup54.9 (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)OGIB subgroup60.5 (57.2-63.9)83.6 (80.9-86.0)1.2 (0.9-1.6)Crohns disease subgroup55.3 (48.0-62.4)85.4 (79.0-90.8)2.6 (1.6-3.9)Neoplastic lesions subgroup55.9

9、(46.0-65.6)84.2 (75.8-91.1)2.1 (0.7-4.3)第十六页，共四十五页。Detailed clinically significant findings by capsule endoscopy in the patients with obscure GI bleedingStudy typeProcedure rangeStudiesProcedures (patients)Positive proceduresDetailed findings/total procedures reportedAngiodysplasiaInflammation/ulcer

10、Neoplastic lesionFresh bloodOtherProspective0-3019316 (305)181167/27581481123431-5018773 (730)468439/6902389339531651-10011804 (804)454398/73420511535251810081425 (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/

11、4871383131-503129 (129)7324/4817320251-10010843 (840)577333/502136118333016100112760 (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)第十七页，共四十五页。胶囊内镜对小肠疾病诊断

12、有价值第十八页，共四十五页。Results for complete visualization of the stomachComplete visualization, 61 patients Gastric areaNo.%Cardia5488.5Fundus5285.2Body5793.4Antrum5386.9Pylorus5488.5Jean-Francois Rey Gastrointestinal Endoscopy Volume 75, Issue 2, Pages 373381第十九页，共四十五页。第二十页，共四十五页。Results for complete visual

13、ization of the stomachGastric areaNo.%Cardia5488.5Fundus5285.2Body5793.4Antrum5386.9Pylorus5488.5Complete visualization, 61 patients 第二十一页，共四十五页。第二十二页，共四十五页。胶囊内镜机器人姿态控制系统第二十三页，共四十五页。第二十四页，共四十五页。BeforeAfterTimer plug乳果糖/钡剂RFID tagUncoated exposed window for fluid erosion聚对二甲苯包衣12mmPatency CapsuleSpad

14、a C. et.al. A novel diagnositc tool for detecting functional patency of the small bowel: the Given patency capsule. Endoscopy 2005;37;9:793-800第二十五页，共四十五页。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Capsule disintegrates after 40 hours-Patency provenIngestionScanning*(24-36 hours)Patency NOT proven*If Given Pa

15、tency Scanner is contraindicated, use fluoroscopy试验流程Spada C. et.al. A novel diagnositc tool for detecting functional patency of the small bowel: the Given patency capsule. Endoscopy 2005;37;9:793-800第二十六页，共四十五页。第二十七页，共四十五页。第二十八页，共四十五页。Suture marker lesion detection rates of a colonoscope, unmodifie

16、d MiroCam capsule endoscope,and SCE 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)Overall polyp detection rate (%)1003186第二十九页，共四十五页。OMOM pH食道无线监测系统第三十页，共四十五页。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第三十一页，共四十五页。Factors/lesions responsible for or associa

17、ted with capsule retention Reasons (diseases)Prospective studies, no. (%)Retrospective studies, no. (%)Total, no. (%)Total39145184Not reported153348Reported24112136Crohns disease6 (25.0)42 (37.5)48 (35.3)Neoplastic lesions9 (37.5)21 (18.8)30 (22.1)NSAID-induced enteropathy2 (8.3)23 (20.5)25 (18.4)Po

18、stsurgical stenosis2 (8.3)8 (7.1)10 (7.4)Intestinal adhesion0 (0)4 (3.6)4 (2.9)Tuberculosis0 (0)3 (2.7)3 (2.2)Ischemia-induced stenosis0 (0)2 (1.8)2 (1.5)Radiation enteritis1 (4.2)2 (1.8)3 (2.2)Meckels diverticulum1 (4.2)1 (0.9)2 (1.5)Pouch1 (4.2)1 (0.9)2 (1.5)Peptic ulcer scar with stricture0 (0)1

19、(0.9)2 (0.7)Cryptogenic multifocal ulcerous stenosing enteritis0 (0)1 (0.9)1 (0.7)Ulceration2 (8.3)3 (2.7)5 (3.7)Gastrointestinal Endoscopy Volume 71, 2010 第三十二页，共四十五页。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第三十三页，共四十五页。What is already known on this topic Video retention in the small bowel may occur in 1.4% to 13% of cases. What this study adds to our knowledge In a retrospective study of 904 studies, 8 patients retained the video were successfully removed by using double-balloon 第三十四页，共四十五页。第三十五页，共四十五页。胶囊嵌顿并穿透第三十六页，共四十五页。在严重脊柱侧弯的患者中，胶囊内镜卡在了支气管中第三十七页，共四十五页。发生