Angsuwatcharakon Phonthep, Kulpatcharapong Santi, Chuncharunee Alan, Khor Christopher, Devereaux Benedict, Moon Jong Ho, Ratanachu-Ek Thawee, Wang Hsiu Po, Pausawasdi Nonthalee, Maydeo Amit, Itoi Takao, Ponnudurai Ryan, Ramchandani Mohan, Nakai Yousuke, Seo Dong Wan, Ogura Takeshi, Tang Raymond Sy, Kongkam Pradermchai, Makmun Dadang, Dy Frederick, Ridtitid Wiriyaporn, Kuo Yu Ting, Pham Khanh Cong, Oung Borathchakra, Lee Jeffrey, Rerknimitr Rungsun
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Endosc Int Open. 2024 Sep 16;12(9):E1065-E1074. doi: 10.1055/a-2366-7302. eCollection 2024 Sep.
The first Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma were published in 2013. Since then, new evidence on the role of endoscopy for management of malignant hilar biliary obstruction (MHBO) has emerged. To update the recommendation, we reviewed the literature using a PICO (population/intervention/comparison/outcomes) framework and created consensus statements. The expert panel voted anonymously using the modified Delphi method and all final statements were evaluated for the quality of evidence and strength of recommendation. The important points with inadequate supporting evidence were classified as key concepts. There were seven statements and five key concepts that reached consensus. The statements and key concepts dealt with multiple aspects of endoscopy-based management in MHBO starting from diagnosis, strategies and options for biliary drainage, management of recurrent biliary obstruction, management of cholecystitis after biliary stenting, and adjunctive treatment before stenting. Although the recommendations may assist physicians in planning the treatment for MHBO patients, they should not replace the decision of a multidisciplinary team in the management of individual patients.
首份关于肝门部胆管癌内镜及介入治疗的亚太地区共识性建议于2013年发布。自那时起，关于内镜在恶性肝门部胆管梗阻（MHBO）治疗中作用的新证据不断涌现。为更新该建议，我们采用PICO（人群/干预措施/对照/结局）框架对文献进行了回顾，并制定了共识声明。专家小组采用改良德尔菲法进行匿名投票，所有最终声明均针对证据质量和推荐强度进行了评估。支持证据不足的要点被归类为关键概念。共有七条声明和五个关键概念达成了共识。这些声明和关键概念涉及MHBO基于内镜治疗的多个方面，从诊断、胆管引流的策略和选择、复发性胆管梗阻的管理、胆管支架置入术后胆囊炎的管理，到支架置入前的辅助治疗。尽管这些建议可能有助于医生为MHBO患者制定治疗方案，但在个体患者的管理中，它们不应取代多学科团队的决策。
