Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Dig Endosc. 2024 Nov;36(11):1195-1210. doi: 10.1111/den.14825. Epub 2024 Jun 6.
The consensus-based TOKYO criteria were proposed as a standardized reporting system for endoscopic transpapillary biliary drainage. The primary objective was to address issues arising from the inconsistent reporting of stent outcomes across studies, which has complicated the comparability and interpretation of study results. However, the original TOKYO criteria were not readily applicable to recent modalities of endoscopic biliary drainage such as biliary drainage based on endoscopic ultrasound or device-assisted endoscopy. There are increasing opportunities for managing hilar biliary obstruction and benign biliary strictures through endoscopic drainage. Biliary ablation has been introduced to manage benign and malignant biliary strictures. In addition, the prolonged survival times of cancer patients have increased the importance of evaluating overall outcomes during the period requiring endoscopic biliary drainage rather than solely focusing on the patency of the initial stent. Recognizing these unmet needs, a committee has been established within the Japan Gastroenterological Endoscopy Society to revise the TOKYO criteria for current clinical practice. The revised criteria propose not only common reporting items for endoscopic biliary drainage overall, but also items specific to various conditions and interventions. The term "stent-demanding time" has been defined to encompass the entire duration of endoscopic biliary drainage, during which the overall stent-related outcomes are evaluated. The revised TOKYO criteria 2024 are expected to facilitate the design and reporting of clinical studies, providing a goal-oriented approach to the evaluation of endoscopic biliary drainage.
共识导向的东京标准被提出作为内镜经乳头胆道引流的标准化报告系统。主要目的是解决由于研究之间支架结果报告不一致而导致的问题，这使得研究结果的可比性和解释变得复杂。然而，原始的东京标准并不适用于最近的内镜胆道引流方式，如基于内镜超声或器械辅助内镜的胆道引流。通过内镜引流来管理肝门部胆道梗阻和良性胆道狭窄的机会越来越多。胆道消融术已被引入来治疗良性和恶性胆道狭窄。此外，癌症患者的生存时间延长，使得在需要内镜胆道引流的期间评估整体结果变得更加重要，而不仅仅是关注初始支架的通畅性。认识到这些未满足的需求，日本胃肠病内镜学会成立了一个委员会来修订东京标准以适应当前的临床实践。修订后的标准不仅提出了内镜胆道引流的一般报告项目，还提出了针对各种情况和干预措施的具体项目。“支架需求时间”一词被定义为涵盖整个内镜胆道引流的持续时间，在此期间评估与支架相关的整体结果。预计修订后的 2024 年东京标准将有助于临床研究的设计和报告，为内镜胆道引流的评估提供目标导向的方法。
