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目的比较胶囊内镜和双气囊小肠镜对小肠疾病的阳性检出率。方法从 Medline、Embase、Elsevier ScienceDirect 和中国期刊全文数据库中检索比较胶囊内镜和双气囊小肠镜对小肠疾病阳性检出率的前瞻性研究。对各项研究中2种内镜的阳性检出率比数比(OR)行荟萃分析,经异质性检验后采用固定效应模型或随机效应模型进行统计分析。并根据可能产生异质性的原因进行分层分析。结果共有8项研究入选(n=277)。荟萃结果表明,胶囊内镜和双气囊小肠镜对小肠疾病阳性检出率没有显著差别[170/277比156/277,随机效应模式:OR 为1.21(95%可信区间 CI:0.64,2.29)]。分层分析提示:胶囊内镜的阳性率显著高于未采用经口和经肛这2种进镜方式相结合的双气囊小肠镜[137/219比110/219,固定效应模式:OR 为1.67(95%CI:1.14,2.44),(P<0.01)];而低于用这2种进镜方式相结合的双气囊小肠镜检查,但差异没有统计学意义[26/48比37/48,随机效应模式:OR 0.33(95%CI:0.05,2.21),(P>0.05)]。进一步对5项全文发表的关于对不明原因消化道出血诊断的研究进行荟萃,结果仍然提示胶囊内镜的阳性检出率明显高于未采用经口和经肛这2种进镜方式相结合的双气囊小肠镜[118/191比96/191,固定效应模式:OR1.61(95%CI:1.07,2.43),(P<0.05)],但显著低于2种进镜方式相结合的双气囊小肠镜检查[11/24比21/24,固定效应模式:OR 0.12(95%CI:0.03,0.52),(P<0.01)]。结论双气囊小肠镜经口和经肛2种进镜方式联合应用的阳性率可能高于胶囊内镜,对这2种内镜的选择,应该取决于病人的一般状况及其意愿,医疗单位所具备的能力,以及病灶是否可能需要采取进一步的介入治疗。
Objective To compare the positive detection rate of small bowel disease by capsule endoscopy and double balloon enteroscopy. Methods A prospective study was conducted to compare the positive detection rate of small bowel disease with capsule endoscopy and double balloon enteroscopy in Medline, Embase, Elsevier ScienceDirect and Chinese Journal Full-text Database. In each study, the positive rate of the two endoscopy was compared with the odds ratio (OR) in the meta-analysis. After the heterogeneity test, the fixed effect model or the random effect model was used for statistical analysis. And according to the possible causes of heterogeneity stratification analysis. Results A total of eight studies were enrolled (n = 277). The meta-analysis showed that there was no significant difference in the positive detection rate of small bowel disease between capsule endoscopy and double-balloon enteroscopy (170/277 vs 156/277, OR = 1.21 (95% confidence interval CI: 0.64, 2.29) ]. Hierarchical analysis suggested that the positive rate of capsule endoscopy was significantly higher than that of the double-balloon enteroscopy without the combination of the two types of endoscopic and transanal approach [137/219 vs 110/219, mode of fixation effect: OR 1.67 (95% CI: 1.14,2.44) (P <0.01)], but lower than the double balloon enteroscopy combined with these two kinds of endoscopic approach, but the difference was not statistically significant [26/48 vs 37/48 , Random effects pattern: OR 0.33 (95% CI: 0.05, 2.21), (P> 0.05)]. A further meta-analysis of the five full-text published studies on the diagnosis of unexplained gastrointestinal bleeding results still suggest that the positive detection rate of capsule endoscopy was significantly higher than the combination of the two kinds of entrance mirror without oral and anal Double balloon enteroscopy (118/191 vs. 96/191, fixed effect pattern: OR1.61 (95% CI: 1.07, 2.43), (P <0.05) Airbag enteroscopy [11/24 vs. 21/24, fixed effect pattern: OR 0.12 (95% CI: 0.03, 0.52), (P <0.01)]. Conclusions The positive rate of double balloon enteroscopy combined with oral and transanal enteroscopy may be higher than that of capsule endoscopy. The choice of these two kinds of endoscopy should depend on the general condition of patients and their wishes. The medical units The ability to have it, and whether the lesion may need further intervention.