Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri 64128-2295, USA.
Am J Gastroenterol. 2010 Feb;105(2):258-73; quiz 274. doi: 10.1038/ajg.2009.684. Epub 2009 Dec 22.
These recommendations provide an evidence-based approach to the role of esophageal stents in the management of benign and malignant diseases. These guidelines have been developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the Board of Trustees. The following guidelines are based on a critical review of the available scientific literature on the topic identified in Medline and PubMed (January 1992-December 2008) using search terms that included stents, self-expandable metal stents, self-expandable plastic stents, esophageal cancer, esophageal adenocarcinoma, esophageal squamous cell carcinoma, esophageal stricture, perforations, anastomotic leaks, tracheoesophageal fistula, and achalasia. These guidelines are intended for use by health-care providers and apply to adult, but not pediatric, patients. As with other practice guidelines, these guidelines are not intended to replace clinical judgment but rather to provide general guidelines applicable to the majority of patients. Clinicians need to integrate recommendations with their own clinical judgment, and with individual patient circumstances, values, and preferences. They are intended to be flexible, in contrast to standards of care, which are inflexible policies designed to be followed in every case. Specific recommendations are based on relevant published information. The quality of evidence and strength of recommendations have been assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, which is a system that has been adopted by multiple national and international societies. The GRADE system is based on a sequential assessment of quality of evidence, followed by assessment of the balance between benefits vs. downsides (harms, burden, and costs) and subsequent judgment regarding the strength of recommendation.
这些建议提供了一种循证方法来处理良性和恶性疾病中的食管支架的作用。这些指南是在美国胃肠病学院及其实践参数委员会的主持下制定的，并得到了董事会的批准。以下指南是基于对 Medline 和 PubMed 上有关该主题的现有科学文献的批判性审查，使用的搜索词包括支架、自膨式金属支架、自膨式塑料支架、食管癌、食管腺癌、食管鳞状细胞癌、食管狭窄、穿孔、吻合口漏、气管食管瘘和贲门失弛缓症。这些指南适用于医疗保健提供者，并适用于成人，但不适用于儿科患者。与其他实践指南一样，这些指南并非旨在替代临床判断，而是旨在提供适用于大多数患者的一般指南。临床医生需要将建议与自己的临床判断以及患者的个人情况、价值观和偏好相结合。它们旨在具有灵活性，与护理标准形成对比，后者是旨在在每种情况下都遵循的僵化政策。具体建议是基于相关的已发表信息。使用推荐评估、制定和评估（GRADE）系统评估证据质量和建议强度，该系统已被多个国家和国际学会采用。GRADE 系统基于对证据质量的顺序评估，然后是对收益与弊端（危害、负担和成本）之间的平衡进行评估，以及随后对建议强度的判断。
