诊断学 第15讲胃肠道内镜检查

医院消化科胃肠道内镜检查GastrointestinalEndoscopy胃肠道内镜的分类及发展史

纤维、电子内镜工作原理与构造电子内镜检查的适应症和禁忌症电子内镜检查常见病变的诊断和治疗胃肠道内镜诊断及治疗进展主要内容内镜内镜为经体表插入器械。窥视有关脏器的变化。早期用于诊断。目前已成为介入治疗不可缺少的工具。Endoscope消化道内镜分类（一）上消化道内镜检查（Uppergastrointestinalendoscopy）食管镜

(Esophagoscope)胃镜

(Gastroscope)

十二指肠镜

(Duodenoscope)

消化道内镜分类（二）下消化道内镜检查（Lowergastrointestinalendoscopy）小肠镜

(Enteroscope)结肠镜

(Colonoscope)硬式内镜（Rigidendoscope）纤维内镜（Fiberopticendoscope）电子内镜（Videoendoscope）胶囊内镜（Capsuleendoscope）双气囊电子小肠镜(Double-balloonEnteroscopy)

超声内镜（Ultrasonicendoscope）放大内镜（magnifyingendoscope）内镜的发展史

硬式内镜（1805-1932）早期硬式内镜：1805年德国Bozzine首先提出了内镜的设想，他利用烛光做光源，通过内镜看到了直肠和子宫的内腔；1826年法国的Segales研制成功了膀胱镜与食管镜；1869年德国Kussmaul制成了第一台胃镜。半可曲式胃镜（Semiflexiblelensgastroscope）1932年光学师Wolf和内镜学者Schindler共同研制成功了一种半可曲式胃镜。纤维内镜（1957--）1957年美国的Hirschowits制成了第一台纤维内镜，日本1963年开始生产纤维胃镜。电子内镜（1983--）1983年美国WelohAllyn公司首先开发了世界上第一台电子胃镜（Videoendoscope）胶囊内镜（2000）2000年以色列开发出第一台将图像连续发射至体外的医学照像机，这一台照像机外形酷似药品的胶囊，故俗称胶囊内镜（Capsuleendoscope）双气囊电子小肠镜

推进式电子小肠镜加上两个小小的气囊，便使其能够到达前任所不能到达的地方日本自治医大医院Yamamoto医师最早使用超声内镜（2000）超声内镜（EUS）是将微型的超声探头安置于内镜的前端，在内镜观察上消化道的异常改变的同时，可在距病灶最近的位置对病灶进行超声.放大内镜（2000）通过内镜放大技术可以观测到胃小凹和肠黏膜的细微结构的各种变化.通过它可以得到约100倍（14英寸以上监视器）的高分辨率大画面纤维内镜构造

内镜操作部镜身光源系统附件活检与治疗器械摄影及视频信号采集保存操作部镜身光源纤维内镜工作原理

光源的强光经导光束照亮消化管内腔，图像由物镜、导光束传至目镜后观察。通过附件，可在内镜直视下做活组织检查及摄影等。

电子内镜电子内镜由操作部、插入部、先端部、接续部构成，接续部与视频系统主体相连，通过监视器来观察传输回来的图像。

操作部分配有控制内镜向上下左右弯曲的角度旋钮、送气送水按钮、吸引按钮以及插入诊疗附件的钳子管道观测系统（彩色监视器、中央处理器、光源装置）该监视器具有使用最尖端技术的CCD和极细电子内镜，可以呈现高清晰度的图像。电子内镜构造电子内镜工作原理用电荷耦合器件（CCD）代替纤维镜之导向束将光信号转变为电信号在监视器上进行观察其余部分与纤维内镜相似胃镜检查的适应症(一)

Indicationsof

Gastroscopy消化不良胸骨后疼痛、烧心、上腹疼痛、不适饱胀、食欲下降吞咽困难上消化道出血消瘦、贫血疑有上消化道肿瘤钡餐检查不能确诊病变随访病变胃溃疡、萎缩性胃炎、术后胃、反流性食管炎、Barrett食管等药物治疗前后、手术后需要内镜治疗摘取异物、上消化道出血的止血及食管静脉曲张的硬化剂注射与结扎、食管狭窄的扩张治疗、上消化道息肉摘除胃镜检查的适应症(二)胃镜检查的禁忌症(一)

Contraindicationsof

Gastroscopy严重心肺疾患严重心律失常、主动脉瘤、心力衰竭、心肌梗塞活动期严重呼吸功能不全及哮喘发作期休克、昏迷神志不清、精神失常食管、胃、十二指肠穿孔急性期特殊病变严重咽喉部疾患腐蚀性食管炎和胃炎巨大食管憩室严重颈胸段脊柱畸形暂缓检查疾病急性传染性肝炎或胃肠道传染病需特别消毒措施慢性乙、丙型肝炎或抗原携带者AIDS胃镜检查的禁忌症(二)蠕动波下食管括约肌(LES)loweresophagealsphincter胃底(fundus)

胃体(body)

食道团胃窦(antrum)十二指肠(duodenum)幽门(pylorus)贲门(cardia)胃解剖图上消化道胃镜检查图像正常食道正常食管粘膜呈淡红色或淡黄色，可见毛细血管网。thesquamocolumnarjunctionThesquamocolumnarjunction.Consideredasthetransitionalzonebetweenthesquamousandcolumnarepitheliumofthedistalesophagus.Itisusuallylocated1-2cmabovethecardiasandisidentifiedbyanabruptchangeincolor.Thejunctionshowsconsiderablevariationsandinsomeinstancesishardlyobserved1cmLAGradeAOne(ormore)mucosalbreaknolongerthan5mm,thatdoesnotextendbetweenthetopsoftwomucosalfoldsLAGradeB1cmOne(ormore)mucosalbreakmorethan5mmlong,thatdoesnotextendbetweenthetopsoftwomucosalfoldsLAGradeC1cmOne(ormore)mucosalbreakthatiscontinuousbetweenthetopsoftwo

ormoremucosalfolds,butwhichinvolveslessthan75%ofthecircumferenceLAGradeD1cmOne(ormore)mucosalbreakwhichinvolvesatleast75%oftheoesophagealcircumferenceLundelletalGut45:172-180(1999)LosAngelesclassificationof

refluxoesophagitisDiagnosisMild–ModerateSevereVerySevereRefluxEsophagitisEsophagealerosions.

Areusuallylinear,longitudinallyorientedandnotuncommonlycoveredwithexudates

Barrett'sEsophagus

Barrett'sesophaguswithanirregularsquamocolumnarjunctionextendingupwardsasymmetricallyLugolstaininginBarrett'sesophagus.

ThecolumnarepitheliumofBarrett'sesophagus(glycogendepleted)remainsunstainedwhilethenormalnon-keratinizedsquamousepithelium(abundantinglycogen)isstained

brown食管贲门粘膜撕裂综合征(Mallory-Weisssyndrome)食管下端贲门大弯侧粘膜纵行撕烈，有血迹。EsophagealVaricesSlightlytortousvenoustrunksrunninglongitudinallythroughtheesophagusEsophagealCancerFungatingandpartiallyulceratedadenocarcinomaoftheloweresophaguscausingobstructioinTheNormalStomachTherugalfoldsofthebodyrunninglongitudinallytowardstheantrumNormalstomach

Arelativelyshortbutnormalstomachwithashapethatpermitstheobservationofboththefornixandpyloruswhileretrovertingtheinstrument'stip.ThefornixandcardiaThefornix(thevaultofthestomach)andthecardia(surroundingtheinstrument'sshaft)arebetterobservedbyretrovertingtheinstrument'stip.Differentbutnormalconfigurationsoftheantrum.AsymmetricalcontractionisobservedonthelowerrightClose-upviewofthepylorus

ChronicGastritis

DiffusemilderythemaofthecorpuschronicathrophicgastritisIncreasedvisibilityofthevascularpatternoftheantrumwithfindingscompatiblewithchronicathrophicgastritisassociatedwithH.pyloriinfection胃粘膜出血(Gastricbleeding)胃粘膜条状出血。StagesofGastriculcerA1A2H1H2S1S2BenignGastricUlcers

Definition

Mucosaldefectspenetratingthroughtheoftheuppergastrointestinaltractthatoccurasaresultofanimbalancebetweenaggressivefactors(gastricacid,pepsin)andgastroduodenaldefensemechanisms.Benigngastriculcerswithacleanbase.a:Spurtinga:Visiblevesselb:Oozingb:AdherentclotC:Flatpigmentedspot

TypeITypeIIForrestClassificationofbleedingpepticulcersType

Ⅲ

Cleanbase急诊胃镜的概念：urgentendoscopy上消化道出血后24-48小时内进行的胃镜检查为急诊胃镜检查。Applicationsforemergency

EndoscopyLocationandidentityofthebleedingsourceWhetherbleedingiscontinuingWhetherbleedingisarterialWhichofmultiphelesionsisbleedingWhetheravisiblevesselispresentinanulcerbaseApplicationsforemergency

EndoscopyuppergastrointestinalbleedingInjectionTherapyuppergastrointestinalbleedinghemoclippingtechniqueuppergastrointestinalbleedingheaterprobeTherapyuppergastrointestinalbleedingInjectionTherapy

Thiscasecorrespondstoapatientpresentingmassiveuppergastrointestinalbleeding.AtendoscopyaDieulafoy-likelesionwithoozingwasfoundatthecardia.Combinedtherapywithinjectionandhemoclipping(nextpage)wassuccessfuluppergastrointestinalbleedinghemoclippingtechniqueSequentialimagesdemonstratingthehemoclippingtechniquetocollapsethebleedingvessel.HeaterProbe

Oozebleedingduringtheinitialtreatmentwiththeheaterprobeofthisangiodysplasia动画片Dieulafoy，sdisease：杜氏病：

又称胃黏膜下横径动脉破裂出血：占消化道出血的0.3%-6.7%，多见于中老年男性，可发生于消化道的任何部位。Fundicglandpolypsofthestomacharesmall,singleormultiple,non-neoplasticprotrusionsmainlylocalizedinthecorpusandfornixofthestomachFundicGlandPolypsSubmucosalTumorsoftheStomach

SmallbenignsubmucosaltumorsofthestomachwithcompletelyintactmucosaBorrman'sClassificationofAdvancedGastricCancerBorrman'sClassificationofAdvancedGastricCancerBorrman'sClassificationofAdvancedGastricCancerBorrman'sClassificationofAdvancedGastricCancerBorrmantype1Adenocarcinoma

Partiallyulceratedpolypoidadenocarcinomaofthecardiacregion.Borrmantype2Adenocarcinoma

UlceratedadenocarcinomaoftheantrumwithdeformityofthelumenBorrmantype3Adenocarcinoma

Infiltratingandpartiallyulceratedadenocarcinoma.Borrmantype4Adenocarcinoma

Diffuselyinfiltratingadenocarcinomawiththickeningofthefoldsandlossofwallelasticity.TheNormalDuodenum

TheduodenalbulbseenafterjustpassingtheinstrumenttipthroughthepylorusDifferentviewsoftheduodenalpapillaasobservedwithaforwardviewinginstrument..duodenitisFourexamplesofpepticduodenitiswithwhiteexudatesanderythemaoftheduodenalmucosaDuodenalulcer

SmallulcerwithfibrinoidnecrosisandsurroundingerythemaontheanteriorwalloftheduodenalbulbDuodenalAdenocarcinoma

Infiltrating,stenoticandpartiallyulcerated,easybleedingadenocarcinomaofthedescendingduodenum.TherapeuticapplicationsofEndosocopyRemovalofforeignbodiesDilationofbenignormalignantesophagealstricturesSclerotherapyofbleedingesophagealvarices(Varicealbanding)ElectrocoagulationoffocalbleedinglesionsPolypectomyDilationofachalasiaPlacementofendoprotesisLeft:Guidewirepassingthroughthemalignantstricture.Right:Expandedmetalstentwiththetipofendoscopereachingitsproximalpart.EndoscopicvaricealligationAfteridentifyingthetargetvarix,endoscopicsuctionisactivatedandthevarixsuctionedintotheligatingcylindertofinallyreleasetheelasticring.Superficialulcerationsappearingafewdaysafterligationtherapy.Elasticringsstillremaininginnecrosedareas.InjectionSclerotherapyofEsophagealVaricesAtpresent,injectionsclerotherapyislessfrequentlyused.Itisagoodalternativeincasesofactiveandprofusebleedingwhereendoscopicviewisdiminishedor,asinthiscase,totheinabilitytopasstheupperesophagealsphincterwiththemountedligatingcylinder.HotBiopsyPolypectomy

Asmallpolypisvisualizedatthecardia.Aftergraspingandpullingthepolypwiththebiopsyforcepselectrocauteryisappliedcoagulatingthebasethatbecomeswhite(zoombyplacingthepointerontherightlowerimage).SnarePolypectomy

Sequentialimagesofapolypectomyaftersubmucosalinjectionof1:10000adrenalineinhypertonicsaline.Theinstrumentisrotatedtogetabetterworkingpositionandthepolypsnared.Finallyelectrocoagulationisappliedandtransectionachieved.DuodenalAdenoma

Sessileadenomaoftheduodenumexcisedwithsnarepreviousinjectionofadrenalineandhypertonicsaline下腹痛、腹泻、便血贫血、腹部肿块、消瘦钡灌肠检查有异常者随访观察结肠癌前病变结肠癌术后需肠镜下治疗者对比观察药物或手术治疗前后IndicationsofColonoscopy结肠镜镜检查的适应症重点肛门直肠严重狭窄畸形急性重度结肠炎重症痢疾、溃疡性结肠炎及憩室炎急性弥漫性腹膜炎腹腔脏器穿孔妊娠严重心肺功能衰竭精神失常及昏迷者Contraindicationsof

Colonoscopy结肠镜镜检查的禁忌症重点大肠的内镜图像Approachingtheileocecalvalvefromthedistance!Thevalveisinitiallyseenasayellowishareawithanindentationbesidethececum.TheNormalRectum

ThetranslucentrectalmucosawithitsclearvascularpatternandprominentHoustonvalves.Submucosalvesselsseenthroughthetranslucentcolorectalmucosa.TheAppendix

orificeOneachimageidentifytheappendixorificewiththemousepointer.LymphocyticColitisUlcerativeColitisRectalstumpwithspontaneousbleedingandmucosalexudatesUlcerativeColitis动画片Crohn'sdisease

Linearulcerationsintheterminalileum.IschemicColitisApalehypoperfundedareasurroundedbymultiplepetechiaeIschemicColitis

LongitudinalinvolvementofthedescendingcolonwithaswollenmucosaaccompaniedbyhemorrhageandexudatesHyperplasticPolypsoftheColonandRectum

Smallhyperplasticpolypoftherectum.Exophyticadenomasofthecolonandrectum

SmallsessileadenomasofthecolonandrectumNon-exophyticColorectalAdenomas

Non-exophyticadenomawithdepression,initiallyseenasareddishareaAdvantagesofChromoscopySmallepithelialneoplasiascanbetterbeobservedanddelimitedbyusingchromoscopymethods.Inthepresentcase,aslightredareawithindistinctbordersisseenontheleftimage(findtheaffectedareawiththemousepointer).Afterchromoscopywithindigocarmine,thelesioniswellcircumscribed.ColonLymphomaPrimarylymphomaofthesigmoidcolonpresentingwithmarkednodularityandinfiltratingdiffuselythecolonicwallbutleavingintactthemucosalsurface.EarlyColorectalCancer

Depressedtype

AdvancedColorectalCancer

ExophyticcolorectalcancerwithcentralexcavationAdvancedColorectalCancer

Exophyticnon-ulceratedcolorectalcancer.HotBiopsyPolypectomy

Asmallpolypisgraspedandpulledwiththebiopsyforcepsandthereafterelectrocauteryisapplied.Thebasethenbecomeswhite.

SnarePolypectomiApedunculatedadenomawithalongstalkthatfacilitatesitsremovalwithasnare消化内镜诊断及治疗进展

内镜下早期胃癌的诊断和治疗微小胃癌（microgastriccancer）为病灶最大径≤5mm的早期胃癌小胃癌（smallgastriccancer）为病灶最大径>5-10mm的早期胃癌早期胃癌的特殊类型早期胃癌的相关概念胃癌前状态（precancerouscondition）癌前疾病（precancerousdiseases）癌前病变（precancerouslesions）癌前疾病（precancerousdiseases）与胃癌相关的胃良性疾病有发生胃癌的危险性，为临床概念如慢性萎缩性胃炎、胃溃疡、胃息肉、手术后胃、肥厚性胃炎、恶性贫血等癌前病变（precancerouslesions）已证实与胃癌发生密切相关的病理变化即异型增生[上皮内瘤变（intraepithelialneoplasia）]，为病理学概念。

早期胃癌的相关概念癌前病变：异型增生【低级别上皮内瘤变=轻度和中度异型增生，高级别上皮内瘤变=重度异型增生和原位癌】

早期胃癌的相关概念低级别上皮内瘤变图d胃的原位癌应是指癌细胞仅限胃腺管内尚未突破腺管基底膜的癌。

ConceptofearlygastriccancerEarlygastriccancerisdefincedasbeingconfinedtothemucosaorthesubmucosa,regardlessofthepresenceortheabsenceofregionallymph-nodemetastasis.早期胃癌(earlygastriccancer，EGC)是指局限于胃黏膜层或黏膜下层癌，不管有无淋巴结的转移。MacroscopictypesofearlygastriccancerType0:Superficial,flattumorswithorwithoutminimalelevationordepressionType0－ⅠType0－ⅡaType0－ⅡbType0－ⅡcType0－ⅢSubtypesoftype0ProtrudedtypeSuperficialelevatedtypeFlattypeSuperficialdepressedtypeExcavatedtypeGastriccancer(1998)1:10-24胃黏膜局部颜色的轻度变化：变红或变白；黏膜下血管网的消失；黏膜颗粒样变厚或凹陷等。早期胃癌的内镜下表现EarlyGastricCancerIIctypeearlygastriccancerseenasanerodedareaonthemajorcurvature色素胃镜(chromoendoscopy)指把一定浓度的色素或染料喷洒或涂布于胃黏膜使普通胃镜下观察到的病灶变得更加清晰明确的一种胃镜诊断方法。目前常用0．2％靛胭脂indigocarmine，IC)喷洒涂布整个胃黏膜或黏膜的可疑病变处沉积在胃小凹的靛胭脂呈现浅蓝色与胃黏膜的橘红色形成了鲜明的对比。

Gastricadenomaonthemajorcurvatureseenasanon-welldefinedsessileelevation.Afterindingocarminesprayingthelesionbecomesclearer色素内镜下早期胃癌可以表现为：表面呈现颗粒样或结节样凹凸异常。颜色发红或褪色，黏膜下的血管紊乱或消失。病变区易出血，黏膜僵硬等；靛胭脂的染色可以使活检有更好的针对性。放大胃镜(magnifyingendoscopy，ME)具有高像素和高分辨率特点的电子内镜可达到与解剖显微镜相同的观察水平有利于观察微细结构变化Tajiri等发现，普通内镜对EGC总诊断准确率为66．7％放大内镜为91．7％。超声胃镜(endoscopiculrasonography。EUS)可以清晰地观察到胃黏膜的黏膜层、黏膜肌层、黏膜下层、固有肌层、浆膜层5层结构可以准确地测定出胃壁各层的厚度因此可以用来判断早期胃癌的浸润深度和有无周围淋巴结转移共聚焦胃镜

(confocallaserendomicroscopy

)在内镜末端加上一个极小的激光共聚焦显微镜它最高可使内镜下的图像放大1000倍，利用它可以清晰地显示胃粘膜小凹、细胞以及亚细胞水平的显微结构。它所显示的是胃黏膜的同一水平横断面的显微图像，而不能同时显示胃黏膜的5层结构。窄带成像(narrowbandimagingNBI)普通内镜光源发出宽波光，能展现黏膜的自然原色但是对黏膜浅表血管或黏膜组织状态（即pitpatterns）的细微变化的强调效果并不明显。NBI利用光的传导和吸收特性(波长短者深入到胃黏膜的厚度浅，波长长者深入到胃黏膜的厚度深)将传统宽光谱的红、绿、蓝三色滤色镜换成窄光谱短波长的光源使胃镜检查对黏膜表层的血管影像显示更加清楚。Treatmentstrategyofearlygastriccancer

EMR

andESDEndoscopicmucosalresection(EMR)Endoscopicsubmucosaldissection(ESD)EndoscopicresectionStandardEMRmethodsEMRStripbiopsyCap-fittedpanendoscopeEMRwithligations(EMR-C)(EMR-L)ERHSEBy1984anEMRtechniquecalledthe“stripbiopsy”wasfirstdescribed

adouble-channelendoscopeisusedAftersubmucosalinjectionofsalineunderthelesionthelesionisliftedusingagrasper,whileasnare,insertedthroughthesecondworkingchannel,isusedtoremovethelesion.StripbiopsyERHSEIn1988anothertechnique,EMRwiththelocalinjectionofhypertonicsaline/dilutedepinephrinesolutionwasdescribed.aftertheinjectionofhypertonicsalineanddilutedepinephrine.Theperipgeryofthelesioniscutusinganeedleknifethelesionisthenremovedusingasnare.高渗盐溶液注射后粘膜切除术Cap-fittedpanendoscope安装透明帽的广视野内镜in1992AmethodofEMRwithacap-fittedpanendoscope(EMR-C)wasdeveloped.Thetechniqueutilizesaclearplasticcapisconnectedtothetipofastandardendoscope.Afterthesubmucosalinjectionofthelesionaspecializedcrescent-shapedsnareisdeployedinthegrooveatthetipofthecapThelesionisthensuckedintothecapresectioncanbesafelyperformedthroughthesubmucosallayerunderthelesion.EMRwithligations(EMR-L)usesastandardendoscopicvaricealligationdevicetocapturethelesionmakeitintoapolypoidlesionbydeployingthebandunderneathit.ThelesionaboveorbelowthebandisthenexcisedEMRtumorslessthan2cminsizeitisdifficulttoresectsuchlargetumorsenblochigherrecurrencerateESDEMRtoESDGanToKagakuRyoho.2007Aug;34(8):1163-7

EndoscopistsdesiredtodevelopanewtechniqueforreliableendoscopicenblocresectionforvariouslesionsEndoknivesforESDSubmucosalinjectionresectinglargerlesionStandardESDmethodsSeveralspotsweremarkedwithaneedleknifeorargonplasmacoagulation5-10mmoutsidemarginofthelesion(1)Afterinjectionof10%glycerinsolutionwith0.0025%epinephrineintothesubmucosaaninitalincisionwasmadewithaneedleknifeoutsidethelineofspotsESD(

2)TheITknifeortheHookknifewastheninsertedintotheinitialincisionelectrosurgicalcurrentwasappliedwiththeuseofanelectrosurgicalgeneratortocompletethecircumferentialmucosalincisionaroundthelesion.ESD(3)InjectionwasrepeatedwithneedlefurtherresectionwascarriedouttoensuretotalremovalofthelesionESD(4)specimenManagementafterESD切除的肿瘤组织要木块固定Indigocarmine染色测量大小内镜下照相小肠疾病的诊断现状

SmallintestineConventionallynotreachablebyOGDandcolonoscopyDifficulttodiagnosesmallbowelpathologiesNoMan'sLand!

CommonClinicalProblemsGIbleedingofobscure(unknown)originChronicrecurrentabdominalpainAssessmentofIBD小肠出血的发病率小肠出血占总GI出血的3-5%小肠出血一般指Treitz韧带到回盲瓣之间的小肠病变引起的肠道出血50岁以下患者小肠出血的病因以肿瘤最多见，60岁以上以血管畸形更为多见Ghosh，Watts，Kinnear.Managementofgastrointestinalhaemorrhage［J］.PostgraduateMedicalJournal，2002，78（915）：4-14.Concha，Ronald，Amaro，etal.ObscureGastrointestinalBleeding：DiagnosticandTherapeuticApproach［J］.JournalofClinicalGastroenterology，2007，41（3）：242-251.小肠出血的病因学病名 国内

国外血管病变 8-14%

50-70%小肠肿瘤 11-60%

15-20%

良恶性 良>恶

恶>良 部位 空>回

回>空炎症病变 5-7%

10-15%憩室病 2-3%

5-11%其他 10-20%

10-18%

--张德中《胃肠病学》2002，7（2）：96

小肠出血的检查手段

一般检查手段

生化、肿瘤、免疫，CT,MR,GI等

特殊检查手段

--小肠钡灌 --99mTc扫描

--电子小肠镜 --DSA血管造影

--胶囊内镜--

CTenteroclysis

--双气囊小肠镜--FleischerDE,GastrointestEndo,2003,56:452ConventionalInvestigationsPushenteroscopyBamealfollow-throughSmallbowelenemaCTscanCTenteroclysisMesentericangiogramRBCscan（1）双气囊电子小肠镜

(Double-balloonEnteroscopy)(2)双气囊电子小肠镜

(Double-balloonEnteroscopy)工作原理：利用两个气囊的相对运动将肠管收缩到外套管上，从而使内镜进得更远

内镜长度：2m外径：9mm

检查时间：较长病人耐受性：在镇静或麻醉下进行

检查路径:

经口、经肛及经口-经肛三种诊断:

病变组织活检行病理检查治疗:息肉切除，黏膜切除

病变部位:反复观察经口途径经肛门途径正常小肠黏膜空肠回肠淋巴滤泡正常小肠绒毛空肠绒毛空-回肠多发性血管

扩张症伴出血空-回肠交界血管畸形伴出血（手术证实）出血坏死性小肠炎空肠肿瘤伴出血

（胃Ca术后10年，GI出血8年）小肠检查真正革命性的飞跃是无痛的人性化的胶囊内镜

（CAPSULEENDOSCOPY）

固定电话——手机（1）M2A®CapsuleComponents1.Opticaldome2.Lensholder3.Lens4.IlluminatingLEDs5.CMOSimage6.Battery7.ASIC(ApplicationSpecificIntegratedCircuit)transmitterAntenna

Dimensions:

Height:11mm Width:27mm Weight:3.7gr（2）TheGiven®DiagnosticSystemAmbulatoryDataRecorder™

onabeltRAPID®applicationforimageprocessingandviewingM2A®Capsule(3)HistoryofCapsuleEndoscopyPaulSwain:EndoscopistGavrielIddan:S