Schusselé Filliettaz S, Juillerat P, Burnand B, Arditi C, Windsor A, Beglinger C, Dubois R W, Peytremann-Bridevaux I, Pittet V, Gonvers J-J, Froehlich F, Vader J-P
Healthcare Evaluation Unit, Institute of Social and Preventive Medicine, University of Lausanne and Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Endoscopy. 2009 Mar;41(3):218-26. doi: 10.1055/s-0028-1119627. Epub 2009 Mar 11.
To summarize the published literature on assessment of appropriateness of colonoscopy for investigation of chronic diarrhea, management of patients with known inflammatory bowel disease (IBD), and for colorectal cancer (CRC) surveillance in such patients, and to report report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II.
A systematic search of guidelines, systematic reviews, and primary studies regarding the evaluation of chronic diarrhea, the management of IBD, and colorectal cancer surveillance in IBD was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions.
According to the literature, colonoscopic evaluation may be justified for patients aged > 50 years with recent-onset chronic diarrhea or with alarm symptoms. Surveillance colonoscopy for CRC should be offered to all patients with extensive ulcerative colitis or colonic Crohn's disease of 8 years' duration, and to all patients with less extensive disease of 15 years' duration. Intervals for surveillance colonoscopy depend on duration of evolution, initial diagnosis, and histological findings. The EPAGE II criteria also confirmed the appropriateness of diagnostic colonoscopy for diarrhea of > 4 weeks' duration. They also suggest that, in addition to assessing extent of IBD by colonoscopy, further colonoscopic examination is appropriate in the face of persistent or worsening symptoms. Surveillance colonoscopy in IBD patients was generally appropriate after a lapse of 2 years. In the presence of dysplasia at previous colonoscopy, it was not only appropriate but necessary.
Despite or perhaps because of the limitations of the available published studies, the panel-based EPAGE II (http://www.epage.ch) criteria can help guide appropriate colonoscopy use in the absence of strong evidence from the literature.
总结已发表的关于结肠镜检查在慢性腹泻调查、已知炎症性肠病（IBD）患者管理以及此类患者结直肠癌（CRC）监测中适用性评估的文献，并报告由专家小组（2008年欧洲胃肠内镜适用性小组，EPAGE II）制定的适用性标准。
对有关慢性腹泻评估、IBD管理以及IBD患者结直肠癌监测的指南、系统评价和原始研究进行系统检索。应用兰德/加州大学洛杉矶分校适用性方法制定这些情况下结肠镜检查的适用性标准。
根据文献，对于年龄>50岁的近期发生慢性腹泻或有警示症状的患者，结肠镜评估可能是合理的。对于所有患有广泛性溃疡性结肠炎或病程达8年的结肠克罗恩病患者，以及所有患有病程达15年的较不广泛性疾病的患者，均应提供CRC监测结肠镜检查。监测结肠镜检查的间隔时间取决于病程、初始诊断和组织学检查结果。EPAGE II标准也证实了诊断性结肠镜检查对于病程>4周的腹泻的适用性。它们还表明，除了通过结肠镜检查评估IBD的范围外，面对持续或恶化的症状时进一步的结肠镜检查也是合适的。IBD患者一般在2年后进行监测结肠镜检查是合适的。如果先前结肠镜检查发现发育异常，不仅合适而且必要。
尽管现有已发表研究存在局限性，或者可能正因如此，基于专家小组的EPAGE II（http://www.epage.ch）标准可在缺乏文献有力证据的情况下帮助指导结肠镜检查的合理使用。
