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ANHANG zum Literaturverzeichnis
Vollständige Daten aus der oralen Präsentation zweier Multizenterstudien der Kapselendoskopie
bei unklaren Blutungen (DDW/UEGW 2002, Daten von Dr. Pennazio und Dr. Gay autorisiert)
Zur Literaturstelle [20]
Delvaux M, et al.
Comparison of wireless endoscopic capsule and push-enteroscopy in patients with obscure
occult/overt digestive bleeding: Results of a prospective, blinded, multicenter trial.
(eingereicht)
-
60 Patienten, alle mit KE und PE, 32 okkult, 28 overt, 2 technische Kapsel-Versager,
deswegen nur Daten von 58 Patienten; mittlerer Hb 9,4 ± 2,5 g /dL. Blinde und unabhängige
Befundung (bei der KE durch zwei Untersucher). Keine Komplikationen
-
Wichtige Einteilung in Relevanz der Läsionen: P0 (vermutlich irrelevant: venöse Ektasie,
Divertikel, Knötchen); P1 (fraglich relevant: rote Flecken, kleine Ulzera); P2 (vermutlich
relevant: angiome, Tumoren, Ulzera, portale Hypertension)
-
Von 58 Pat. 15 negativ mit KE und PE, 19 positiv mit KE und PE, 21 pos. KE, aber neg.
PE, 3 pos. PE, aber negativ KE
-
Interobserver-Übereinstimmung: 59 % bei P0, 51 % bei P1 und 76 % bei P2
Zu den Literaturstellen [19]
[45]*
Pennazio M, et al.
Title: Capsule endoscopy in patients with obscure gastrointestinal bleeding: diagnostic
yield, comparison with push enteroscopy, and effect on clinical outcome (Manuskript
in Vorbereitung)
-
100 Patienten mit Kapsel-Endoskopie (KE) untersucht, davon 51 auch mit Push-Enteroskopie
(PE). Im Gesamtkollektiv (n=100) Blutungsintensität: 62 overt, 39 okkult, 4,7 Episoden,
4,5 Transufusionen, Dauer im Mittel 32 Monate, mittlerer Hb 7,2 (4,5-11). Kapselzeiten
Magen 43 min (1-240), Dünndarm 250 min (101-410), in 24 % Zökum nicht erreicht, davon
bei 5 Patienten mit Strikturen (2 Crohn, 2 unklar, 1 Tumor) musste die Kapsel endoskopisch
(n=1) oder operativ (n=4, alle elektiv) entfernt werden; bei allen 5 Patienten bestanden
keine klinischen Hinweise auf eine Obstruktion und bei allen war das Dünndarm- Röntgen
normal gewesen.
-
Treffsicherheit in der Gesamtgruppe (n=100): 47/100 (26/62 overt, 18/38 okkult), 5
unentdeckte Crohn-Fälle, 3 Tumoren
-
Im Vergleichskollektiv (n=51) Treffsicherheit KE 59 %, PE 29 %, in 24 % beide pos.;
KE in 18/36 der neg. PE-Fälle pos, PE in 3/21 der neg. KE-Fälle positiv
-
Outcome (Daten von n=86; aber nur kurzer follow-up von 11 Monaten): In der KE-pos.
Gruppe keine Blutung mehr bei 81 %, in der KE-negativen Gruppe 58 %. Management: KE-pos.
Gruppe 42 % medizinisch, 31 % endoskopisch, 22 % operativ; KE-neg. Gruppe 70 % medizinisch,
10 % endoskopisch, 8 % operativ
Gegenüber der DDW-Präsentation mit 57 Patienten (ref. [19]) wurden bei der UEGW 89 Patienten vorgestellt (ref. [45]).
1 * Bezeichnung der Evidenzgrade nach: Preventive Service Task Force. Guide to clinical
preventive services: Report of the US Preventive Service Task Force. 2nd edition edition. Baltimore: Williams and Wilkins 1996
Prof. Dr. Thomas Rösch
II. Medizinische Klinik rechts der Isar, Der Technischen Universität München
Ismaninger Str. 22
81675 München
Telefon: +49/89/41 40-47 85
Fax: +49/89/41 40-48 72
eMail: Thomas.Roesch@lrz.tum.de
