Maluf-Filho Fauze, Dotti Carlos Marcelo, Farias Alberto Queiroz, Kupski Carlos, Chaves Dalton Marques, Artifon Everson, Nakao Frank, Rossini Giulio Fabio, Paulo Gustavo Andrade de, Ardengh José Celso, Silva José Edmilson Ferreira da, Rossini Lucio, Lima Luiz Felipe Pereira de, Averbach Marcelo, Cury Marcelo S, D'Aassunção Marco Aurélio, Silva Marcus Clarêncio, Ney Marcus Vinicius, Spinosa Sérgio, Matuguma Sérgio E, Guaraldi Simone, Arantes Vitor, Mello Vera Helena
Sociedade Brasileira de Endoscopia Digestiva, Brazil.
Arq Gastroenterol. 2007 Oct-Dec;44(4):353-8. doi: 10.1590/s0004-28032007000400014.
In the last 20 years, several papers have focused on demonstrating the impact of endoscopic ultrasonography findings on the management of different clinical scenarios in digestive disease. This fact is an indirect evidence of the difficulty of popularization of the method. On other hand, the limited availability of endoscopic ultrasonography in Brazil is a direct evidence of this limitation. This was the rationale for the organization of a consensus meeting on endoscopic ultrasonography. It was aimed to identify the best evidence that support the use of endoscopic ultrasonography in gastroenterology.
A panel of experts on endoscopic ultrasonography was selected based on the files of the Gastroenterology and Endoscopy Societies and on the registries of endoscope manufacturers. Two members of the meeting selected the relevant topics that were transformed into questions. The topics and the questions were debated among the experts five months before the consensus meeting. The experts were asked to perform systematic reviews in order to answer the questions so it could be possible to grade the answers based on the strength of the evidence. During the two days of the meeting the answers were presented, debated and voted. Consensus was reached when a minimum of 70% of the voters were in agreement. The final consensus report was submitted to the experts' evaluation and approval.
Seventy nine questions were debated by the experts at the pre-Consensus meeting. As the result of this debate 85 questions came out and were assigned to the members of the panel. During the Consensus meeting 22 experts debated and voted 85 answers. Consensus was reached for several clinical scenarios for which the impact of endoscopic ultrasonography findings were supported by level 1 evidences: differential diagnosis of subepithelial lesions and thickening of gastric folds, staging and diagnosis of unresectable esophageal cancer, indirect signs of peritoneal involvement of gastric cancer, MALT gastric lymphoma and rectal cancer staging, diagnosis of common bile duct and gallbladder stones, diagnosis of chronic pancreatitis and differential diagnosis of a solid mass in chronic pancreatitis, differential diagnosis of the pancreatic cyst, prediction of the results of the endoscopic treatment of esophageal varices and diagnosis and staging of non-small cell lung cancer.
There are the highest levels of evidences that support the indication of endoscopic ultrasonography for several digestive diseases and even for non-small cell lung cancer.
在过去20年里，多篇论文致力于证明内镜超声检查结果对消化系统疾病不同临床情况管理的影响。这一事实间接证明了该方法推广的困难。另一方面，巴西内镜超声检查的可及性有限是这一局限性的直接证据。这就是组织一次内镜超声检查共识会议的基本原理。其目的是确定支持在胃肠病学中使用内镜超声检查的最佳证据。
根据胃肠病学和内镜学会的档案以及内镜制造商的登记记录，挑选了一组内镜超声检查专家。会议的两名成员选择了相关主题并将其转化为问题。这些主题和问题在共识会议前五个月由专家们进行了讨论。要求专家们进行系统评价以回答这些问题，从而能够根据证据强度对答案进行分级。在会议的两天时间里，展示了答案并进行了讨论和投票。当至少70%的投票者达成一致时，达成共识。最终的共识报告提交给专家进行评估和批准。
在共识会议前，专家们讨论了79个问题。经过这次讨论，产生了85个问题并分配给了专家小组的成员。在共识会议期间，22名专家对85个答案进行了讨论和投票。对于几种临床情况达成了共识，内镜超声检查结果的影响得到了1级证据的支持：上皮下病变和胃皱襞增厚的鉴别诊断、不可切除食管癌的分期和诊断、胃癌腹膜受累的间接征象、黏膜相关淋巴组织胃淋巴瘤和直肠癌分期、胆总管和胆囊结石的诊断、慢性胰腺炎的诊断以及慢性胰腺炎实性肿块的鉴别诊断、胰腺囊肿的鉴别诊断、食管静脉曲张内镜治疗结果的预测以及非小细胞肺癌的诊断和分期。
有最高水平的证据支持内镜超声检查用于多种消化系统疾病甚至非小细胞肺癌的适应证。
