Miyazaki Masaru, Yoshitomi Hideyuki, Miyakawa Shuichi, Uesaka Katsuhiko, Unno Michiaki, Endo Itaru, Ota Takehiro, Ohtsuka Masayuki, Kinoshita Hisafumi, Shimada Kazuaki, Shimizu Hiroaki, Tabata Masami, Chijiiwa Kazuo, Nagino Masato, Hirano Satoshi, Wakai Toshifumi, Wada Keita, Isayama Hiroyuki, Okusaka Takuji, Tsuyuguchi Toshio, Fujita Naotaka, Furuse Junji, Yamao Kenji, Murakami Koji, Yamazaki Hideya, Kijima Hiroshi, Nakanuma Yasuni, Yoshida Masahiro, Takayashiki Tsukasa, Takada Tadahiro
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
J Hepatobiliary Pancreat Sci. 2015 Apr;22(4):249-73. doi: 10.1002/jhbp.233. Epub 2015 Mar 18.
The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract and ampullary carcinomas in 2008. Novel treatment modalities and handling of clinical issues have been proposed after the publication. New approaches for editing clinical guidelines, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, also have been introduced for better and clearer grading of recommendations.
Clinical questions (CQs) were proposed in seven topics. Recommendation, grade of recommendation and statement for each CQ were discussed and finalized by evidence-based approach. Recommendation was graded to grade 1 (strong) and 2 (weak) according to the concept of GRADE system.
The 29 CQs covered seven topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, (6) radiation therapy, and (7) pathology. In 27 CQs, 19 recommendations were rated strong and 11 recommendations weak. Each CQ included the statement of how the recommendation was graded.
This guideline provides recommendation for important clinical aspects based on evidence. Future collaboration with cancer registry will be a key for assessment of the guidelines and establishment of new evidence. Free full-text articles and a mobile application of this guideline are available via http://www.jshbps.jp/en/guideline/biliary-tract2.html.
日本肝胆胰外科学会于2008年发布了胆管癌和壶腹癌管理的临床实践指南。自该指南发布后，提出了新的治疗方式及临床问题的处理方法。同时也引入了新的临床指南编辑方法，如推荐分级评估、制定与评价（GRADE）系统，以便对推荐意见进行更完善、更清晰的分级。
针对七个主题提出了临床问题（CQs）。通过循证方法对每个CQ的推荐意见、推荐等级及说明进行了讨论并最终确定。根据GRADE系统的概念，将推荐等级分为1级（强烈）和2级（弱）。
29个CQs涵盖七个主题：（1）预防性治疗，（2）诊断，（3）胆管引流，（4）手术治疗，（5）化疗，（6）放射治疗，以及（7）病理学。在27个CQs中，19项推荐被评为强烈，11项推荐为弱。每个CQ都包含了推荐等级的说明。
本指南基于证据为重要临床方面提供了推荐意见。未来与癌症登记处的合作将是评估本指南及建立新证据的关键。可通过http://www.jshbps.jp/en/guideline/biliary-tract2.html获取本指南的免费全文文章及移动应用程序。
