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杂志全名及年卷期: Eur J Gastroenterol Hepatol. 2007 Jul;19(7):529-34.

文题:Diagnostic and therapeutic yield of push-and-pull enteroscopy for symptomatic small bowel Crohn's disease strictures.

作者:Pohl J, May A, Nachbar L, Ell C.

英文摘要:OBJECTIVE: Crohn's disease is frequently complicated by obstructive symptoms secondary to small bowel strictures that cannot be accessed by conventional endoscopy. Push-and-pull enteroscopy is a new endoscopic tool that might allow not only diagnostic work-up but also therapeutic interventions of these strictures. The purpose of this study was to evaluate the feasibility and safety of push-and-pull enteroscopy in the treatment of symptomatic small bowel Crohn's disease strictures. METHODS: Between September 2003 and May 2006, 19 consecutive patients with known or suspected Crohn's disease and symptomatic small bowel strictures were subjected to push-and-pull enteroscopy and included in our analysis. RESULTS: With push-and-pull enteroscopy at least one small bowel stricture was accessed in each patient. On the basis of endoscopic assessment strictures in nine patients were not amenable to endoscopic therapy because of anatomical reasons (3/9) or severe inflammatory activity within the stenotic segment (6/9). They underwent direct surgery or intensified immunomodulatory treatment, respectively. In 10 patients with 13 strictures we performed 15 dilations in combination with push-and-pull enteroscopy under fluoroscopic guidance. Technical success was achieved in 8/10 patients, symptomatic relief with avoidance of surgery was achieved in 6/10 patients who remained symptom free during a mean follow-up period of 10 months (range, 4-16 months). No complications were encountered after dilation. CONCLUSIONS: Push-and-pull enteroscopy is very useful for diagnosis and directing therapy in patients with Crohn's disease-associated strictures within the small bowel. Balloon dilation with the push-and-pull enteroscopy device appears safe and effective and can be considered as an alternative to surgery in selected patients with medically refractory strictures.

PMID: 17556897
中文翻译：
题目：推拉内镜对有症状的小肠克隆病狭窄的诊断及治疗效果
摘要：目的：克隆病时常并发小肠狭窄引起的梗阻症状，小肠狭窄部位不能被传统内镜通过。推拉内镜是一个新的内镜检查工具，它不但可以用于诊断而且可以介入治疗这些肠狭窄疾病。被研究目的是评估推拉内镜在治疗有症状的小肠克隆病狭窄的可行性和安全性。方法：自2003年9月-2006年5月，连续收治19例已知或可疑克隆疾病伴小肠狭窄症状的病人，经推拉内镜处理并分析结果。结果：每个病人用推拉内镜至少通过一处小肠狭窄。9例病人在内镜评价狭窄后没有进一步内镜治，因为解剖原因（3/9）或狭窄肠段严重炎症反应的原因（6/9）。他们分别经手术或加强免疫治疗。另10例病人有13处狭窄，在透视导向下通过推拉内镜行共15次扩张治疗。成功8例（8/10），症状缓解免予手术6例（6/10），并且此6例病人平均随访10（分别4-16个月）个月无症状。没有扩张后并发症。结论：推拉内镜检查对小肠克隆病狭窄的诊断和治疗是非常有用的。推拉内镜的气囊扩张显示是安全和有效的并且被认为是对药物治疗无效病人是否选择手术治疗的手段。

点评：克隆病是较难治愈的疾病，原因未明，多见于青年人，表现为肉芽肿性炎症病变，小肠狭窄乃其主要并发症。对于有症状的小肠狭窄，既往多以手术治疗为主，本文作者，运用推拉内镜气囊扩张技术治疗克隆病小肠狭窄，为此病的治疗提供了很好的治疗手段，非常值得推广。

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请注意活动规则，你这篇文章的杂志影响因子只有1.6！－by zwqql

2007-06-12 01:09