Buscaglia Jonathan M, Shin Eun Ji, Giday Samuel A, Kapoor Sumit, Dunbar Kerry B, Eloubeidi Mohamad A, Canto Marcia I, Jagannath Sanjay B
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21205, USA.
Gastrointest Endosc. 2009 Apr;69(4):813-20, quiz 820.e1-17. doi: 10.1016/j.gie.2008.05.036. Epub 2008 Oct 16.
Although pancreatic cystic neoplasms are widely recognized, practice habits among physicians and awareness of consensus guidelines are currently unknown.
To assess the awareness of guidelines and describe variability in practice habits among 2 groups: (1) "general group" of gastroenterologists and surgeons and (2) "EUS group" of specialists in EUS.
An online survey was sent to randomly selected gastroenterologists and surgeons and e-mailed to members of the American Society for Gastrointestinal Endoscopy (ASGE) Special Interest Group in EUS (EUS-SIG).
Response rate for the general group was 8.8% (220/2500) and 9.7% for the EUS group (42/431). EUS specialists were mostly in academic practice (66.7% vs 36.3%, P < .001) and reported seeing 21 to 50 cysts per year (54.8% vs 12.3%, P < .001). The majority of the general group (64.1%) was unaware of any published practice guidelines, compared with 33.3% of EUS specialists (P < .001). Awareness of ASGE guidelines was more frequently reported than other guidelines in both groups and yet was still <50% for each group. Both demonstrated moderate consistency with the International Association of Pancreatology guidelines, appropriately answering 66.7% of the questions. For 9-mm lesions, only 25% of the questions were correctly answered in each group. EUS specialists were less likely to refer main-duct intraductal papillary mucinous neoplasms (IPMN) for surgery and more likely to opt for EUS-guided FNA (compared with high-resolution CT, MRCP, or surgery) for 9-mm, 22-mm, and 34-mm branch-duct IPMNs (P </= .001).
Low response rate and recall bias.
Awareness of practice guidelines about the management of suspected pancreatic cystic neoplasms is lower among general GI physicians compared with EUS specialists. Among all physicians, the greatest variability in practice is in small (<1 cm) lesions.
尽管胰腺囊性肿瘤已广为人知，但目前尚不清楚医生的实践习惯以及对共识指南的知晓情况。
评估指南知晓情况，并描述两组医生的实践习惯差异：（1）胃肠病学家和外科医生组成的“普通组”；（2）超声内镜（EUS）专家组成的“EUS组”。
向随机抽取的胃肠病学家和外科医生发送在线调查问卷，并通过电子邮件发送给美国胃肠内镜学会（ASGE）EUS特别兴趣小组（EUS-SIG）的成员。
普通组的回复率为8.8%（220/2500），EUS组为9.7%（42/431）。EUS专家大多从事学术工作（66.7%对36.3%，P<.001），且报告每年诊治21至50个囊肿（54.8%对12.3%，P<.001）。普通组的大多数人（64.1%）不知道任何已发表的实践指南，而EUS专家中这一比例为33.3%（P<.001）。两组中，报告知晓ASGE指南的比例均高于其他指南，但每组知晓率仍<50%。两组对国际胰腺病学协会指南的符合度均为中等，正确回答了66.7%的问题。对于9毫米的病变，每组仅25%的问题回答正确。EUS专家将主胰管内乳头状黏液性肿瘤（IPMN）转诊手术的可能性较小，而对于9毫米、22毫米和34毫米的分支胰管IPMN，更倾向于选择EUS引导下细针穿刺活检（与高分辨率CT、磁共振胰胆管造影或手术相比）（P≤.001）。
回复率低和回忆偏倚。
与EUS专家相比，普通胃肠科医生对疑似胰腺囊性肿瘤管理实践指南的知晓率较低。在所有医生中，实践差异最大的是小（<1厘米）病变。
