目的:比较胶囊内镜(VCE)和双气囊小肠镜(DBE)对不明原因血管源性消化道出血(OGIB)的诊断准确性。
方法:MEDLINE(通过PubMed),搜索LILACS(通过BVS)和Cochrane/CENTRAL虚拟数据库,查找2017年之前的研究。我们确定了前瞻性和回顾性研究,包括观察,队列,单盲和多中心研究,比较VCE和DBE对OGIB的诊断,收集所有血管来源的出血数据。所有患者均接受相同的金标准方法。然后使用标准化提取形式从每个纳入的研究中提取相关数据。我们计算了研究变量(灵敏度,特异性,患病率,阳性和阴性预测值和准确性),并使用Meta-Disc软件进行荟萃分析。
结果:在每位患者的分析中,包括17项研究(1477个病变)。我们在2043例患者中确定了3150项检查(1722VCE和1428DBE),并确定了2248个出血源,其中1467例来自血管病变。在这些病变中,经VCE诊断864例(58.5%),通过DBE诊断613例(41.5%)。血管源性出血的预测概率为54.34%。DBE的敏感性为84%(95CI:0.82-0.86;异质性:78.00%),特异性为92%(95CI:0.89-0.94;异质性:92.0%)。对于DBE,阳性似然比为11.29(95CI:4.83-26.40;异质性:91.6%),阴性似然比为0.20(95CI:0.15-0.27;异质性:67.3%).CE后进行DBE可使血管病变的诊断率提高7%,从83%到90%。
结论:与分离的DBE相比,使用分离的视频胶囊内窥镜可提高从血管源检测小肠出血的诊断准确性。然而,伴随使用增加了出血源的检出率。
OBJECTIVE: To compare the diagnostic accuracy of video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) in cases of obscure gastrointestinal bleeding (OGIB) of vascular origin.
METHODS: MEDLINE (via PubMed), LILACS (via BVS) and Cochrane/CENTRAL virtual databases were searched for studies dated before 2017. We identified prospective and retrospective studies, including observational, cohort, single-blinded and multicenter studies, comparing VCE and DBE for the diagnosis of OGIB, and data of all the vascular sources of bleeding were collected. All patients were subjected to the same gold standard method. Relevant data were then extracted from each included study using a standardized extraction form. We calculated study variables (sensitivity, specificity, prevalence, positive and negative predictive values and accuracy) and performed a meta-analysis using Meta-Disc software.
RESULTS: In the per-patient analysis, 17 studies (1477 lesions) were included. We identified 3150 exams (1722 VCE and 1428 DBE) in 2043 patients and identified 2248 sources of bleeding, 1467 of which were from vascular lesions. Of these lesions, 864 (58.5%) were diagnosed by VCE, and 613 (41.5%) were diagnosed by DBE. The pretest probability for bleeding of vascular origin was 54.34%. The sensitivity of DBE was 84% (95%CI: 0.82-0.86; heterogeneity: 78.00%), and the specificity was 92% (95%CI: 0.89-0.94; heterogeneity: 92.0%). For DBE, the positive likelihood ratio was 11.29 (95%CI: 4.83-26.40; heterogeneity: 91.6%), and the negative likelihood ratio was 0.20 (95%CI: 0.15-0.27; heterogeneity: 67.3%). Performing DBE after CE increased the diagnostic yield of vascular lesion by 7%, from 83% to 90%.
CONCLUSIONS: The diagnostic accuracy of detecting small bowel bleeding from a vascular source is increased with the use of an isolated video capsule endoscope compared with isolated DBE. However, concomitant use increases the detection rate of the bleeding source.