Schusselé Filliettaz S, Gonvers J-J, Peytremann-Bridevaux I, Arditi C, Delvaux M, Numans M E, Lorenzo-Zúñiga V, Dubois R W, Juillerat P, Burnand B, Pittet V, Vader J-P, Froehlich F
Healthcare Evaluation Unit, Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
Endoscopy. 2009 Mar;41(3):234-9. doi: 10.1055/s-0028-1119625. Epub 2009 Mar 11.
To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of functional bowel symptoms, and 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 and management of functional bowel symptoms was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions.
Much of the evidence for use of colonoscopy in evaluation of chronic abdominal pain, and/or constipation and/or abdominal bloating is modest. Major limitations include small numbers of patients and lack of adequate characterization of these patients. Large community-based follow-up studies are needed to enable better definition of the natural history of patients with functional bowel disorders. Guidelines stress that alarm features ("red flags"), such as rectal bleeding, anemia, weight loss, nocturnal symptoms, family history of colon cancer, age of onset > 50 years, and recent onset of symptoms should all lead to careful evaluation before a diagnosis of functional bowel disorder is made. EPAGE II assessed these symptoms by means of 12 clinical scenarios, rating colonoscopy as appropriate, uncertain and inappropriate in 42 % (5/12), 25 % (3/12), and 33 % (4/12) of these, respectively.
Evidence to support the use of colonoscopy in the evaluation of patients with functional bowel disorders and no alarm features is lacking. These patients have no increased risk of colon cancer and thus advice on screening for this is not different from that for the general population. EPAGE II criteria, available online (http://www.epage.ch), consider colonoscopy appropriate in patients of > 50 years with chronic or new-onset bowel disturbances, but not in patients with isolated chronic abdominal pain.
总结已发表的关于结肠镜检查用于功能性肠病症状调查适宜性的文献，并报告由专家小组——2008年欧洲胃肠内镜适宜性小组（EPAGE II）制定的适宜性标准。
对有关功能性肠病症状评估与管理的指南、系统评价及原始研究进行系统检索。应用兰德/加州大学洛杉矶分校适宜性方法制定针对这些情况的结肠镜检查适宜性标准。
结肠镜检查用于评估慢性腹痛和/或便秘和/或腹胀的证据大多不足。主要局限性包括患者数量少以及对这些患者的特征描述不充分。需要开展大规模基于社区的随访研究，以便更好地界定功能性肠病患者的自然病程。指南强调，诸如直肠出血、贫血、体重减轻、夜间症状、结肠癌家族史、发病年龄>50岁以及症状近期出现等警示特征（“红旗征”），在做出功能性肠病诊断之前均应进行仔细评估。EPAGE II通过12种临床情景对这些症状进行了评估，将结肠镜检查评定为适宜、不确定和不适宜的分别占这些情景的42%（5/12）、25%（3/12）和33%（4/12）。
缺乏支持对无警示特征的功能性肠病患者使用结肠镜检查的证据。这些患者患结肠癌的风险并未增加，因此关于结肠癌筛查的建议与普通人群无异。EPAGE II标准可在网上获取（http://www.epage.ch），该标准认为，对于年龄>50岁的慢性或新发肠道功能紊乱患者，结肠镜检查是适宜的，但对于孤立性慢性腹痛患者则不适宜。
