经内镜逆行胰胆管造影术（ERCP）下胆管黏膜活检在不明原因肝外胆管狭窄中的诊断价值
Clinical practice guideline on the use of single-operator cholangioscopy in the diagnosis of indeterminate biliary stricture and the treatment of difficult biliary stones.
机构信息
School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia.
Department of Gastroenterology, Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia.
出版信息
Surg Endosc. 2024 Feb;38(2):499-510. doi: 10.1007/s00464-023-10569-x. Epub 2023 Dec 26.
BACKGROUND AND AIMS
Single-operator cholangioscopy (SOC) offer a diagnostic and therapeutic alternative with an improved optical resolution over conventional techniques; however, there are no standardized clinical practice guidelines for this technology. This evidence-based guideline from the Colombian Association of Digestive Endoscopy (ACED) intends to support patients, clinicians, and others in decisions about using in adults the SOC compared to endoscopic retrograde cholangiopancreatography (ERCP), to diagnose indeterminate biliary stricture and to manage difficult biliary stones.
METHODS
ACED created a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. Universidad de los Andes and the Colombia Grading of Recommendations Assessment, Development and Evaluation (GRADE) Network supported the guideline-development process, updating and performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The GRADE approach was used, including GRADE Evidence-to-Decision frameworks.
RESULTS
The panel agreed on one recommendation for adult patients with indeterminate biliary strictures and one for adult patients with difficult biliary stones when comparing SOC versus ERCP.
CONCLUSION
For adult patients with indeterminate biliary strictures, the panel made a conditional recommendation for SOC with stricture pattern characterization over ERCP with brushing and/or biopsy for sensitivity, specificity, and procedure success rate outcomes. For the adult patients with difficult biliary stones the panel made conditional recommendation for SOC over ERCP with large-balloon dilation of papilla. Additional research is required on economic estimations of SOC and knowledge translation evaluations to implement SOC intervention in local contexts.
背景与目的
单操作员胆管镜检查（SOC）提供了一种诊断和治疗的替代方法，其光学分辨率优于传统技术；然而，对于这项技术，还没有标准化的临床实践指南。来自哥伦比亚消化内镜协会（ACED）的循证指南旨在支持患者、临床医生和其他人员做出决策，即相对于内镜逆行胰胆管造影术（ERCP），是否使用 SOC 来诊断不确定的胆管狭窄和处理困难的胆管结石。
方法
ACED 成立了一个多学科指南小组，以平衡利益冲突，最大限度地减少潜在的偏见。安第斯大学和哥伦比亚推荐评估、制定与评估（GRADE）网络支持指南的制定过程，更新和进行系统的证据审查。小组根据对临床医生和患者的重要性，对临床问题和结果进行了优先排序。使用了 GRADE 方法，包括 GRADE 证据决策框架。
结果
小组就成人患者不确定的胆管狭窄和成人患者困难的胆管结石比较 SOC 与 ERCP 达成了一项建议。
结论
对于不确定的胆管狭窄的成年患者，小组对 SOC 进行了有条件的推荐，对于敏感性、特异性和程序成功率的结果，推荐 SOC 进行狭窄模式特征描述优于 ERCP 进行刷检和/或活检。对于有困难的胆管结石的成年患者，小组对 SOC 进行了有条件的推荐，优于 ERCP 进行乳头大球囊扩张。需要对 SOC 的经济估计和知识转化评估进行额外的研究，以在当地环境中实施 SOC 干预。
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