诊断学理论与实践

诊断学理论与实践 ›› 2025, Vol. 24 ›› Issue (06): 648-653.doi: 10.16150/j.1671-2870.2025.06.011

• 论著 • 上一篇    下一篇

胶囊内镜联合双气囊小肠镜应用在小肠疾病诊断中的策略

汤铭昱1, 谭盈盈1, 陈丽萍1,2, 杨敬貌3, 钟玲4, 陈海英1(), 陈慧敏1()   

  1. 1.上海交通大学医学院附属仁济医院消化内科， 上海 200001
    2.上海市老年医学中心消化内科， 上海 201104
    3.温州医科大学附属第一医院消化内科， 浙江省温州市 325035
    4.重庆市梁平区人民医院消化内科， 重庆 404000
  • 收稿日期:2025-06-09 修回日期:2025-12-06 出版日期:2025-12-25 发布日期:2025-12-25
  • 通讯作者: 陈海英 E-mail：Chenhaiying@renji.com；
    陈慧敏 E-mail：huimin.chan@foxmail.com
  • 作者简介:第一联系人：*：并列第一作者
  • 基金资助:
    国家自然科学基金(82422011);国家自然科学基金(82403688);国家自然科学基金(82372849);国家自然科学基金(82372732);上海交通大学医学院研究型医师项目(20240806)

The value of capsule endoscopy combined with double-balloon enteroscopy in the diagnosis of small bowel diseases

TANG Mingyu1, TAN Yingying1, CHEN Liping1,2, YANG Jinmao3, ZHONG Ling4, CHEN Haiying1(), CHEN Huimin1()   

  1. 1. Department of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
    2. Department of Gastroenterology and Hepatology, Shanghai Geriatric Medical Center, Shanghai 201104, China
    3. Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Wenzhou 325035, China
    4. Department of Gastroenterology and Hepatology, Liangping District People's Hospital, Chongqing 404000, China
  • Received:2025-06-09 Revised:2025-12-06 Published:2025-12-25 Online:2025-12-25

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摘要：

目的： 分析先进行胶囊内镜（capsule endoscopy， CE）检查，再行双气囊小肠镜（double-balloon enteroscopy， DBE）检查，评估联合应用在小肠疾病中的诊断价值，并探讨CE与DBE间的诊断一致性，为疑似小肠病变患者优化检查流程提供参考。方法： 回顾性分析2020年1月至2025年3月间上海交通大学医学院附属仁济医院连续收治的先行CE检查后再行DBE检查患者的临床资料（154例），比较2种检查方式诊断的差异及一致性，并分析年龄与病变类型对一致性的影响。结果： 154例患者中，CE检出病变率高于DBE检出病变率[93.5%（144/154）比81.8%（126/154），χ2=8.53，P=0.003 5]，且CE对于息肉/息肉样增生的检出率高于DBE（11.7%比5.2%，χ2=3.85，P=0.049）；DBE对于占位/黏膜下病变的检出率高于CE（5.84%比0.65%，χ2=6.4，P=0.011）。在检出病变中，溃疡类疾病检出率最高（68/154），其次为炎症/糜烂、血管畸形/出血、息肉/息肉样增生、占位/黏膜下隆起。CE与DBE的总体诊断一致性一般（κ=0.344，95%CI为0.222~0.467，P<0.001），但在溃疡（κ=0.55）及血管畸形/出血（κ=0.42）的诊断上一致性较高。将患者年龄分别按照<18岁（未成年），18~40岁（青年），40~59岁（中年），≥60岁（老年）进行分层，后行诊断一致性分析显示，40~59岁组CE与DBE的诊断一致率为55.6%（κ=0.122），而18~40岁组和≥60岁组的诊断一致率46.20%（κ=0.447）、44.10%（κ=0.446）。结论： CE与DBE检查在小肠疾病诊断中具有互补性，CE可作为初筛工具以优化目标导向的DBE检查，两者联合应用可提高小肠血管畸形和息肉的诊断效能；推荐基于患者的年龄及病变特征的个体化序贯检查策略。

关键词: 胶囊内镜, 双气囊小肠镜, 小肠疾病, 诊断一致性

Abstract:

Objective To analyze the diagnostic value of application of capsule endoscopy (CE) followed by double-balloon enteroscopy (DBE) in small bowel diseases, and to explore the diagnostic concordance between CE and DBE, thereby optimizing the examination workflow for patients with suspected small bowel lesions. Methods A retrospective analysis was conducted on the clinical data of 154 consecutive patients who underwent CE followed by DBE at Renji Hospital, Shanghai Jiao Tong University School of Medicine, between January 2020 and March 2025. The diagnostic concordance between the two examination modalities were assessed, and the influence of age and lesion type on concordance was analyzed. Results For the 154 patients who underwent CE followed by DBE in this study, the lesion detection rate of CE was higher than that of DBE [93.5%(144/154) vs 81.8%(126/154), χ2 = 8.53, P=0.003 5], and the detection rate of polyps/poly-poid hyperplasia by CE was higher than that by DBE (11.7% vs 5.2%, χ2=3.85, P=0.049). The detection rate of mass/submucosal lesions by DBE was higher than that by CE (5.84% vs 0.65%, χ2=6.4, P=0.011). Among the detected lesions, the detection rate of ulcerative diseases was highest (68/154), followed by inflammation/erosion, vascular malformation/blee-ding, polyps/polypoid hyperplasia, and mass/submucosal elevation. The overall diagnostic concordance between CE and DBE was moderate (κ=0.344, 95%CI 0.222-0.467, P<0.001), but higher concordance was observed for the diagnosis of ulcers (κ=0.55) and vascular malformation/bleeding (κ=0.42). After stratifying patients by age into 18 years (minors), 18-40 years (young adults), 40-59 years (middle-aged adults), and ≥60 years (elderly), the results of diagnostic consistency analysis showed that in the 40-59 years group, the diagnostic concordance rate between CE and DBE was 55.6% (κ=0.122), while in the 18-40 years group and the ≥60 years group, the diagnostic concordance rates were 46.20% (κ=0.447) and 44.10% (κ=0.446), respectively. Conclusions CE and DBE examinations are complementary in the diagnosis of small bowel diseases. CE can serve as a preliminary screening tool to optimize DBE examination. The sequentially combined application of the two can improve the diagnostic efficiency for small bowel vascular malformations and polyps. It is recommended to develop individualized sequential examination strategies based on patient age and lesion characteristics.

Key words: Capsule endoscopy, Double-balloon enteroscopy, Small bowel diseases, Diagnostic concordance

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