Clinical Practice Guidelines for the Use of Video Capsule Endoscopy
Clinical Practice Guidelines for the Use of Video Capsule Endoscopy
复制标题
DOI：
10.1053/j.gastro.2016.12.032
复制
发表时间：
2017-02-01
期刊：
影响因子：
29.4
通讯作者：
Sadowski, Daniel
中科院分区：
文献类型：
--
作者：
Enns, Robert A.;Hookey, Lawrence;Sadowski, Daniel
背景与目的：视频胶囊式内窥镜（CE）提供了一种评估小肠的非侵入性选择，但其在内窥镜手术和横断面成像方面的应用差异很大。该共识的目的是为临床实践中CE的适当使用提供指导。方法：一项系统性文献检索确定了在克罗恩病、乳糜泻、胃肠道出血和贫血患者中使用CE的研究。使用推荐评估、开发和评价分级（GRADE）方法对证据质量和推荐强度进行评级。结果：共识包括21项声明，重点关注小肠CE和结肠胶囊式内窥镜的使用。当回结肠镜检查和影像学检查结果为阴性时，如果必须了解小肠中是否存在活动性克罗恩病，则建议对疑似、已知或复发性克罗恩病患者进行CE检查。不建议慢性腹痛或腹泻患者使用，因为没有证据表明与克罗恩病相关的生物标志物异常。建议CE评估尽管接受了适当治疗但仍有不明原因症状的乳糜泻患者，但不进行诊断。对于有明显消化道出血且食管胃镜检查和结肠镜检查结果阴性的患者，应尽快进行CE检查。CE仅推荐用于不明原因的轻度慢性缺铁性贫血患者。建议在需要小肠研究的息肉综合征或其他小肠癌患者中进行CE监测。胶囊式结肠镜不应常规替代结肠镜检查。应让患者了解CE的潜在风险，包括手术失败、胶囊滞留或遗漏病变。最后，应确定CE培训和报告的标准化标准。结论：CE通常应被视为消化道出血、克罗恩病或乳糜泻患者的补充检查，这些患者的内镜或影像学检查结果为阴性或不确定。
BACKGROUND & AIMS: Video capsule endoscopy (CE) provides a noninvasive option to assess the small intestine, but its use with respect to endoscopic procedures and cross-sectional imaging varies widely. The aim of this consensus was to provide guidance on the appropriate use of CE in clinical practice. METHODS: A systematic literature search identified studies on the use of CE in patients with Crohn's disease, celiac disease, gastrointestinal bleeding, and anemia. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. RESULTS: The consensus includes 21 statements focused on the use of small-bowel CE and colon capsule endoscopy. CE was recommended for patients with suspected, known, or relapsed Crohn's disease when ileocolonoscopy and imaging studies were negative if it was imperative to know whether active Crohn's disease was present in the small bowel. It was not recommended in patients with chronic abdominal pain or diarrhea, in whom there was no evidence of abnormal biomarkers typically associated with Crohn's disease. CE was recommended to assess patients with celiac disease who have unexplained symptoms despite appropriate treatment, but not to make the diagnosis. In patients with overt gastrointestinal bleeding, and negative findings on esophagogastroduodenoscopy and colonoscopy, CE should be performed as soon as possible. CE was recommended only in selected patients with unexplained, mild, chronic iron-deficiency anemia. CE was suggested for surveillance in patients with polyposis syndromes or other small-bowel cancers, who required small-bowel studies. Colon capsule endoscopy should not be substituted routinely for colonoscopy. Patients should be made aware of the potential risks of CE including a failed procedure, capsule retention, or a missed lesion. Finally, standardized criteria for training and reporting in CE should be defined. CONCLUSIONS: CE generally should be considered a complementary test in patients with gastrointestinal bleeding, Crohn's disease, or celiac disease, who have had negative or inconclusive endoscopic or imaging studies.