Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022
Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022
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DOI：
10.1055/a-1973-3796
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发表时间：
2022-11-24
期刊：
影响因子：
9.3
通讯作者：
Triantafyllou, Konstantinos
中科院分区：
文献类型：
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作者：
Pennazio, Marco;Rondonotti, Emanuele;Triantafyllou, Konstantinos
主要建议MR 1 ESGE建议将小肠胶囊式内窥镜作为一线检查，考虑到胶囊式内窥镜的出色安全性、患者耐受性及其可视化整个小肠粘膜的潜力，在考虑其他内窥镜和放射学诊断检查疑似小肠出血之前。强烈建议，中等质量证据：MR 2 ESGE建议在出血事件发生后尽快对疑似小肠明显出血的患者进行小肠胶囊式内窥镜检查，理想情况下在48小时内，以最大限度地提高诊断和后续治疗效果。强烈建议，高质量证据。MR 3 ESGE不建议疑似小肠出血或缺铁性贫血患者在小肠胶囊内镜检查前进行常规二次内镜检查。强烈建议，低质量证据。MR 4 ESGE建议对疑似小肠出血且小肠胶囊式内窥镜检查结果为高质量阴性的患者进行保守治疗。强烈建议，中等质量证据。MR 5 ESGE建议器械辅助肠镜检查以确认并可能治疗小肠胶囊式内窥镜检查发现的病变。强烈建议，高质量的证据。MR 6 ESGE建议在需要小肠评估时，将小肠胶囊式内窥镜作为缺铁性贫血患者的一线检查。强烈建议，MR 7 ESGE建议小-在疑似克罗恩病且回结肠镜检查结果阴性的患者中，将肠胶囊内镜作为初步诊断方式，小肠，无梗阻症状或已知肠狭窄。强烈建议，高质量证据。MR 8 ESGE建议，对于专用小肠横断面成像无显著或非诊断性结果的患者，如果认为可能影响患者管理，则将小肠胶囊式内窥镜作为后续检查。强烈建议，低质量证据。MR 9 ESGE建议，在确诊克罗恩病的患者中，在小肠胶囊式内窥镜检查前使用通畅胶囊以降低胶囊留存率。强烈建议，中等质量证据。MR 10 ESGE建议使用器械辅助肠镜检查（DAE）作为非急性肠梗阻患者小肠内异物取出手术的替代方法。强烈推荐，中等质量证据。MR 11 ESGE推荐DAE-内镜逆行胰胆管造影术（DAE-ERCP）作为一线内镜方法治疗解剖结构改变的胰胆管疾病患者（Billroth II患者除外）。强烈推荐，中等质量证据。
Main RecommendationsMR1 ESGE recommends small-bowel capsule endoscopy as the first-line examination, before consideration of other endoscopic and radiological diagnostic tests for suspected small-bowel bleeding, given the excellent safety profile of capsule endoscopy, its patient tolerability, and its potential to visualize the entire small-bowel mucosa.Strong recommendation, moderate quality evidence.MR2 ESGE recommends small-bowel capsule endoscopy in patients with overt suspected small-bowel bleeding as soon as possible after the bleeding episode, ideally within 48 hours, to maximize the diagnostic and subsequent therapeutic yield.Strong recommendation, high quality evidence.MR3 ESGE does not recommend routine second-look endoscopy prior to small-bowel capsule endoscopy in patients with suspected small-bowel bleeding or iron-deficiency anemia.Strong recommendation, low quality evidence.MR4 ESGE recommends conservative management in those patients with suspected small-bowel bleeding and high quality negative small-bowel capsule endoscopy.Strong recommendation, moderate quality evidence.MR5 ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by small-bowel capsule endoscopy.Strong recommendation, high quality evidence.MR6 ESGE recommends the performance of small-bowel capsule endoscopy as a first-line examination in patients with iron-deficiency anemia when small bowel evaluation is indicated.Strong recommendation, high quality evidence.MR7 ESGE recommends small-bowel capsule endoscopy in patients with suspected Crohn's disease and negative ileocolonoscopy findings as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known bowel stenosis.Strong recommendation, high quality evidence.MR8 ESGE recommends, in patients with unremarkable or nondiagnostic findings from dedicated small-bowel cross-sectional imaging, small-bowel capsule endoscopy as a subsequent investigation if deemed likely to influence patient management.Strong recommendation, low quality evidence.MR9 ESGE recommends, in patients with established Crohn's disease, the use of a patency capsule before small-bowel capsule endoscopy to decrease the capsule retention rate.Strong recommendation, moderate quality evidence.MR10 ESGE recommends device-assisted enteroscopy (DAE) as an alternative to surgery for foreign bodies retained in the small bowel requiring retrieval in patients without acute intestinal obstruction.Strong recommendation, moderate quality evidence.MR11 ESGE recommends DAE-endoscopic retrograde cholangiopancreatography (DAE-ERCP) as a first-line endoscopic approach to treat pancreaticobiliary diseases in patients with surgically altered anatomy (except for Billroth II patients).Strong recommendation, moderate quality evidence.