胶囊内镜诊断新进课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,胶囊内镜诊断新进,胶囊内镜诊断新进胶囊内镜诊断新进,胶囊内镜诊断新进胶囊内镜诊断新进胶囊内镜诊断新进,1,内镜发展史,Kussmaul(,德国,),Hirschowitz(,美国,),CCD,NOTES,治疗内镜,色素内镜,细胞内镜,内镜发展史Kussmaul(德国)Hirschowitz(美,2,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,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、,3,有效性,有效性,4,食管病变,食管病变,5,胶囊内镜诊断新进课件,6,胶囊内镜诊断新进课件,7,胶囊内镜诊断新进课件,8,肠道恶性淋巴瘤,肠道恶性淋巴瘤,9,肠道海绵状血管瘤,肠道海绵状血管瘤,10,小肠腺癌,小肠腺癌,11,卵巢癌侵犯盲肠,卵巢癌侵犯盲肠,12,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,65,40,16,148,成功率,98.46%,100%,93.75%,97.29%,阳性率,73.4%,75%,75%,84.46%,病种,小肠炎,18,15,5,43,Crohn,病,3,-,3,1,胃肠息肉,7,9,-,14,P-J,综合征,1,-,-,2,血管畸形,9,2,3,23,憩室,3,2,2,5,蠕虫,3,-,1,12,小肠占位,3,-,2,15,胃癌,-,1,-,-,结肠炎,/,癌,-,1,-,1,淋巴滤泡增生,-,-,1,5,OMOM胶囊内镜临床应用初步评价作者张齐联李秀梅李红灵,13,SCI,文献,SCI文献,14,Indications of,capsule endoscopy in the final included original articles,Study type,Procedures, range,Studies,Procedures (patients),Detailed indications reported,OGIB,Crohns disease,Neoplastic lesions,Celiac disease,Clinical symptoms only,Other,Healthy subjects,Prospective,0-30,59,1116 (1103),1086,413,314,175,57,80,38,9,31-50,44,1793 (1749),1793,1048,393,92,97,101,62,0,51-100,29,2118 (2117),2118,1505,109,55,3,152,294,0,100,17,3521 (3493),3521,2454,252,50,47,117,541,60,Total (%),149,8547 (8462),8518,5420 (63.6),1068 (12.5),372 (4.4),204 (2.4),450 (5.3),935 (11.0),69 (0.8),Retrospective,0-30,14,254 (254),254,115,47,9,15,50,18,0,31-50,9,405 (403),405,279,84,11,0,28,3,0,51-100,23,1812 (1809),1812,1284,191,51,11,226,47,2,100,32,11,820 (11,737),11,183,7525,905,343,151,1604,552,103,Total (%),78,14,293 (14,291),13,654,9203 (67.4),1227 (9.0),414 (3.0),177 (1.3),1908 (14.0),620 (4.5),105 (0.8),Total (%),227,22,840 (22,753),22,172,14,623 (66.0),2295 (10.4),786 (3.5),381 (1.7),2358 (10.6),1555 (7.0),174 (0.8),Indications of capsule endosco,15,Detection rate, complete examination, and retention rate of,capsule endoscopy,in patients with different indications,Study type,Subgroup,Detection rate (%),Completion rate (%),Retention rate (%),Prospective,Overall,58.8 (55.4-62.2),84.8 (82.9-86.6),1.0 (0.7-1.3),OGIB subgroup,58.6 (54.3-62.8),84.4 (81.3-87.2),0.9 (0.5-1.4),Crohns disease subgroup,58.8 (51.3-66.0),89.3 (82.8-94.4),2.8 (1.6-4.5),Neoplastic lesions subgroup,56.5 (43.5-69.0),85.6 (75.8-93.2),1.8 (0.5-4.0),Retrospective,Overall,60.5 (55.5-65.5),81.3 (78.7-83.8),1.7 (1.3-2.1),OGIB subgroup,63.9 (58.5-69.1),82.0 (76.7-86.7),1.7 (1.1-2.4),Crohns disease subgroup,45.5 (30.6-60.9),74.6 (69.2-79.7),2.8 (3.1-7.6),Neoplastic lesions subgroup,54.9 (38.2-71.1),79.1 (64.1-90.9),5.7 (1.8-18.3),Sum,Overall,59.4 (56.5-62.2),83.5 (82.0-85.0),1.4 (1.2-1.6),OGIB subgroup,60.5 (57.2-63.9),83.6 (80.9-86.0),1.2 (0.9-1.6),Crohns disease subgroup,55.3 (48.0-62.4),85.4 (79.0-90.8),2.6 (1.6-3.9),Neoplastic lesions subgroup,55.9 (46.0-65.6),84.2 (75.8-91.1),2.1 (0.7-4.3),Detection rate, complete exami,16,Detailed clinically significant findings by,capsule endoscopy in the patients with obscure GI bleeding,Study type,Procedure range,Studies,Procedures (patients),Positive procedures,Detailed findings/total procedures reported,Angiodysplasia,Inflammation/ulcer,Neoplastic lesion,Fresh blood,Other,Prospective,0-30,19,316 (305),181,167/275,81,48,11,23,4,31-50,18,773 (730),468,439/690,238,93,39,53,16,51-100,11,804 (804),454,398/734,205,115,35,25,18,100,8,1425 (1425),791,327/708,198,59,36,7,27,Total (%),56,3318 (3264),1894,1331/2407,722 (54.2),315 (23.7),121 (9.1),108 (8.1),65 (4.9),Retrospective,0-30,4,64 (64),37,32/48,7,13,8,3,1,31-50,3,129 (129),73,24/48,17,3,2,0,2,51-100,10,843 (840),577,333/502,136,118,33,30,16,100,11,2760 (2760),1737,1031/1823,493,287,79,43,129,Total (%),28,3796 (3793),2424,1420/2421,653 (46.0),421 (29.6),122 (8.6),76 (5.4),148 (10.4),Total,84,7114 (7057),4318,2751/4828,1375 (50.0),736 (26.8),243 (8.8),184 (6.7),213 (7.7),Detailed clinically significan,17,胶囊内镜对小肠疾病诊断有价值,胶囊内镜对小肠疾病诊断有价值,18,Results for complete visualization of the stomach,Complete visualization, 61 patients,Gastric area,No.,%,Cardia,54,88.5,Fundus,52,85.2,Body,57,93.4,Antrum,53,86.9,Pylorus,54,88.5,Jean-Francois Rey,Gastrointestinal Endoscopy,Volume 75, Issue 2, Pages 373381,Results for complete visualiza,19,胶囊内镜诊断新进课件,20,Results for complete visualization of the stomach,Gastric area,No.,%,Cardia,54,88.5,Fundus,52,85.2,Body,57,93.4,Antrum,53,86.9,Pylorus,54,88.5,Complete visualization, 61 patients,Results for complete visualiza,21,胶囊内镜诊断新进课件,22,胶囊内镜机器人姿态控制系统,胶囊内镜机器人,23,胶囊内镜诊断新进课件,24,Before,After,Timer plug,乳果糖,/,钡剂,RFID tag,Uncoated exposed window for fluid erosion,聚对二甲苯,包衣,12mm,Patency Capsule,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,BeforeAfterTimer plug乳果糖/钡剂RFI,25,40,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 proven,Ingestion,Scanning*,(24-36 hours),Patency NOT proven,*If Given,Patency 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;9:793-800,40小时后，试验囊崩解Capsule disintegrat,26,胶囊内镜诊断新进课件,27,胶囊内镜诊断新进课件,28,Suture marker lesion detection rates of a colonoscope, unmodified MiroCam capsule endoscope,and SCE,1,4,4 (100),2 (50),3 (75.0),2,8,8 (100),1 (12.5),8 (100),3,6,6 (100),2 (33.3),5 (83.3),4,7,7 (100),2 (28.5),6 (85.7),Overall polyp detection rate (%),100,31,86,Suture marker lesion detection,29,OMOM pH,食道无线监测系统,OMOM pH食道无线监测系统,30,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,胶囊内镜检查并发症胶囊滞留1-5%,31,Factors/lesions responsible for or associated with,capsule retention,Reasons (diseases),Prospective studies, no. (%),Retrospective studies, no. (%),Total, no. (%),Total,39,145,184,Not reported,15,33,48,Reported,24,112,136,Crohns disease,6 (25.0),42 (37.5),48 (35.3),Neoplastic lesions,9 (37.5),21 (18.8),30 (22.1),NSAID-induced enteropathy,2 (8.3),23 (20.5),25 (18.4),Postsurgical stenosis,2 (8.3),8 (7.1),10 (7.4),Intestinal adhesion,0 (0),4 (3.6),4 (2.9),Tuberculosis,0 (0),3 (2.7),3 (2.2),Ischemia-induced stenosis,0 (0),2 (1.8),2 (1.5),Radiation enteritis,1 (4.2),2 (1.8),3 (2.2),Meckels diverticulum,1 (4.2),1 (0.9),2 (1.5),Pouch,1 (4.2),1 (0.9),2 (1.5),Peptic ulcer scar with stricture,0 (0),1 (0.9),2 (0.7),Cryptogenic multifocal ulcerous stenosing enteritis,0 (0),1 (0.9),1 (0.7),Ulceration,2 (8.3),3 (2.7),5 (3.7),Gastrointestinal Endoscopy,Volume 71,2010,Factors/lesions responsible fo,32,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,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2,33,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,What is already known on this,34,胶囊内镜诊断新进课件,35,胶囊嵌顿并穿透,胶囊嵌顿并穿透,36,在严重脊柱侧弯的患者中，胶囊内镜卡在了支气管中,在严重脊柱侧弯的患者中，胶囊内镜卡在了支气管中,37,发生胶囊内镜误吸的风险,急性卒中,/,脑血管疾病史,神经系统疾病,重症肌无力 帕金森氏症 唐氏综合症 继发于糖尿病的神经病变,高龄,头颈部疾病、手术或治疗史,心肌梗死,慢性阻塞性肺疾病,长期气管插管史。,发生胶囊内镜误吸的风险急性卒中/脑血管疾病史,38,如果胶囊内镜滞留我们怎么办？,如果胶囊内镜滞留我们怎么办？,39,合理的、措词适当的沟通是必要的,!,合理的、措词适当的沟通是必要的!,40,胶囊滞留部位,=,病变部位，进一步检查,无症状胶囊滞留者经内科治疗后自然排出,胶囊滞留部位 = 病变部位，进一步检查无症状胶囊滞留者经内,41,出现梗阻、穿孔要及时处理,出现梗阻、穿孔要及时处理,42,两镜争议,“,胶囊优先”。,对儿童和高龄老年人的检查,尚未发生任何严重问题。,双侧录像摄像机的应用,(,具有绝佳的光学控制功能,),胶囊内镜将会获得空前的可视化效果。,结肠检查的胶囊内镜已经开发出来,但目前未获得,FDA,的批准。,微型手术刀的胶囊内镜。,胶囊内镜的缺陷包括小肠检查不够全面,其发生率约,15%,大概仅有,1%,的需回收的胶囊滞留率。,两镜争议“胶囊优先”。,43,两镜争议,对于高度怀疑有小肠疾病的患者,可应用双气囊小肠镜,在消化道中部出血以及存在小肠狭窄的情况下,双气囊小肠镜是一个可靠且有效的方法,使用双气囊小肠镜,可以准确定位正在出血的病灶,从而成功止血。,另外,双气囊小肠镜还能到达胶囊内镜无法到达的地方。例如,当小肠输入袢存在病变时,可以将双气囊小肠镜固定于此,从而提供一个高度清晰的可视画面,另外,双气囊小肠镜检查导致小肠损伤的风险也很小,目前双镜联合治疗是胶囊内镜不可替代的手段 总之,在患者明确存在小肠病变时,应该优先考虑双气囊小肠镜。,两镜争议对于高度怀疑有小肠疾病的患者,可应用双气囊小肠镜,44,谢谢！,谢谢！,45,汇报结束,谢谢大家,!,请各位批评指正,汇报结束谢谢大家!请各位批评指正,46,