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不确定来源的胃肠道出血:建议什么诊断策略?
Mathilde Boullier1, Audrey Fohlen2, Stéphanie Viennot3
1Digestive surgery department, university hospital center, avenue de la Côte-de-Nacre, 14000 Caen, France.
Journal of visceral surgery
|June 21, 2023
概括
不确定的胃肠道出血 (GBUO) 往往起源于小肠,这给诊断带来了挑战. 视频囊内镜 (VCE) 是推的第一步,如果VCE是禁忌或不确定的,则使用其他方法.
科学领域:
- 胃肠病学 胃肠病学
- 诊断内镜检查 诊断内镜检查
- 最少侵入性的手术
背景情况:
- 源不明的胃肠道出血 (GBUO) 缺乏确定的原因/位置,尽管标准内镜检查.
- GBUO通常源于小肠病理 (血管,炎症,瘤).
- 定位GBUO是一个重大的诊断挑战.
研究的目的:
- 概述来源不明的胃肠道出血的诊断策略.
- 突出先进的内镜和成像技术在小肠探索中的作用.
- 为GBUO管理建立基于共识的方法.
主要方法:
- 视频囊内镜 (VCE) 作为一线调查.
- 对于怀疑肠道阻塞 (VCE禁忌) 的CT-肠镜检查.
- 肠镜检查 (诊断/治疗) 是VCE或CT-肠镜检查之后的第二线检查.
- 针对耐火/复发病例的手术内肠镜检查 (IOE).
主要成果:
- VCE是欧洲对GBUO的首选初步研究.
- 当怀疑阻塞时,CT-肠镜作为替代的第一线方法.
- 肠镜对于治疗干预或在初始VCE/CT-肠镜后进一步诊断至关重要.
- IOE只适用于复杂的治疗需求或诊断失败.
结论:
- 使用VCE,CT-肠镜和肠镜的逐步诊断方法对GBUO有效.
- 最少侵入性技术已经改善了对GBUO的小肠探索.
- 在GBUO管理的特定情况下,IOE起着至关重要的作用.
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