Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece.
Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden.
Endoscopy. 2021 Sep;53(9):970-980. doi: 10.1055/a-1541-2938. Epub 2021 Jul 28.
We aimed to document international practices in small-bowel capsule endoscopy (SBCE), measuring adherence to European Society of Gastrointestinal Endoscopy (ESGE) technical and clinical recommendations.
Participants reached through the ESGE contact list completed a 52-item web-based survey.
217 responded from 47 countries (176 and 41, respectively, from countries with or without a national society affiliated to ESGE). Of respondents, 45 % had undergone formal SBCE training. Among SBCE procedures, 91 % were performed with an ESGE recommended indication, obscure gastrointestinal bleeding (OGIB), iron-deficiency anemia (IDA), and suspected/established Crohn's disease being the commonest and with higher rates of positive findings (49.4 %, 38.2 % and 53.5 %, respectively). A watchful waiting strategy after a negative SBCE for OGIB or IDA was preferred by 46.7 % and 70.3 %, respectively. SBCE was a second-line exam for evaluation of extent of new Crohn's disease for 62.2 % of respondents. Endoscopists adhered to varying extents to ESGE technical recommendations regarding bowel preparation ( > 60 %), use in those with pacemaker holders (62.5 %), patency capsule use (51.2 %), and use of a validated scale for bowel preparation assessment (13.3 %). Of the respondents, 67 % read and interpreted the exams themselves and 84 % classified exams findings as relevant or irrelevant. Two thirds anticipated future increase in SBCE demand. Inability to obtain tissue (78.3 %) and high cost (68.1 %) were regarded as the main limitations, and implementation of artificial intelligence as the top development priority (56.2 %).
To some extent, endoscopists follow ESGE guidelines on using SBCE in clinical practice. However, variations in practice have been identified, whose implications require further evaluation.
本研究旨在记录小肠胶囊内镜（SBCE）的国际实践，评估其对欧洲胃肠道内镜学会（ESGE）技术和临床建议的遵循程度。
通过 ESGE 联系人列表联系参与者，完成了一份包含 52 个项目的在线调查。
来自 47 个国家的 217 人回复了调查（分别有 176 人和 41 人来自有或没有附属 ESGE 的国家协会）。45%的受访者接受过正规的 SBCE 培训。在 SBCE 操作中，91%是根据 ESGE 推荐的适应证进行的，主要是不明原因胃肠道出血（OGIB）、缺铁性贫血（IDA）和疑似/确诊克罗恩病（CD），阳性发现率分别为 49.4%、38.2%和 53.5%。对于 OGIB 或 IDA 阴性的 SBCE 后，46.7%和 70.3%的人倾向于观察等待策略。对于新诊断 CD 的评估，62.2%的受访者将 SBCE 作为二线检查。在技术建议方面，内镜医生对肠道准备（ > 60%）、心脏起搏器携带者的使用（62.5%）、通畅胶囊使用（51.2%）和使用验证的肠道准备评估量表（13.3%）的遵循程度存在差异。67%的受访者阅读并解释了自己的检查结果，84%的人认为检查结果与临床相关或不相关。三分之二的受访者预计 SBCE 的需求将增加。无法获得组织（78.3%）和高成本（68.1%）被认为是主要限制因素，而人工智能的实施被认为是最重要的发展优先事项（56.2%）。
在一定程度上，内镜医生在临床实践中遵循 ESGE 指南使用 SBCE。然而，实践中的差异已经确定，需要进一步评估其影响。
