Exploration morphologique de l’intestin grêle: quels examens pour quelles indications ?

Acta Endoscopica (Impact Factor: 0.16). 06/2009; 39(3):201-205. DOI: 10.1007/s10190-009-0036-9

ABSTRACT Le principal motif d’exploration morphologique de l’intestin grêle est le saignement digestif inexpliqué (SDI) extériorisé
ou non. La principale cause de saignement digestif inexpliqué est la malformation artérioveineuse ou angiodysplasie. La vidéocapsule
(VCE) ingérée est l’examen de première intention de l’intestin grêle en cas de SDI. Elle doit être réalisée le plus précocement
possible en cas de SDI extériorisé (après endoscopies hautes et basses), et présente la meilleure rentabilité diagnostique
par rapport aux explorations radiologiques et endoscopiques alternes. L’entéroscopie à double ballon et les techniques dérivées
(simple ballon et entéroscopie spiralée) permettent la confirmation histologique et le traitement endoscopique (coagulation
par plasma argon, polypectomie) des lésions de l’intestin grêle détectées par VCE ou par un examen radiologique. Le scanner
avec entéroclyse (entéro-TDM) est l’examen radiologique de référence pour le bilan lésionnel des entéropathies (maladie de
Crohn ou maladie coeliaque compliquée) ou le diagnostic des tumeurs de l’intestin grêle et le suivi des polyposes. L’IRM de
l’intestin grêle, non irradiante, pourrait supplanter le scanner dans un futur proche.
The main indication of DBE is obscure gastrointestinal bleeding (OGIB). The main cause of obscure gastrointestinal bleeding
is vascular lesion or angiodysplasia. Capsule endoscopy (CE) is the first examination of the small bowel in the case of OGIB.
It must be done as early as possible when overt bleeding (after upper gastrointestinal endoscopy and colonoscopy), and present
the best diagnostic yield in comparison with radiological techniques and other endoscopic techniques. Double balloon enteroscopy
and similar techniques (single balloon and spiral enteroscopy) allow for histological confirmation and endoscopic treatment
(argon plasma coagulation, polypectomy) of small intestine lesions detected by CE or radiological examination. Computed tomography
enteroclysis is the best radiological examination for the diagnosis of enteropathy (Crohn’s disease or celiac disease with
complications) or the diagnosis of tumours and for monitoring polyposis. Magnetic resonance imaging (MRI) of the small intestine,
without radiation, could supplant the scanner in a near future.

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