Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Gastrointest Endosc. 2024 Nov;100(5):786-796. doi: 10.1016/j.gie.2024.06.002. Epub 2024 Oct 9.
This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for the role of endoscopy in the diagnosis and management of pancreatic masses. This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework and addresses needle selection (fine-needle biopsy [FNB] needle vs FNA needle), needle caliber (22-gauge vs 25-gauge needles), FNB needle type (novel or contemporary [fork-tip and Franseen] vs alternative FNB needle designs), and sample processing (rapid on-site evaluation [ROSE] vs no ROSE). In addition, this guideline addresses stent selection (self-expandable metal stents [SEMS] vs plastic stents), SEMS type (covered [cSEMS] vs uncovered [uSEMS]), and pain management (celiac plexus neurolysis [CPN] vs medical analgesic therapy). In patients with solid pancreatic masses undergoing EUS-guided tissue acquisition (EUS-TA), the ASGE recommends FNB needles over FNA needles. With regard to needle caliber, the ASGE suggests 22-gauge over 25-gauge needles. When an FNB needle is used, the ASGE recommends using either a fork-tip or a Franseen needle over alternative FNB needle designs. After a sample has been obtained, the ASGE suggests against the routine use of ROSE in patients undergoing an initial EUS-TA of a solid pancreatic mass. In patients with distal malignant biliary obstruction undergoing drainage with ERCP, the ASGE suggests using SEMS over plastic stents. In patients with proven malignancy undergoing SEMS placement, the ASGE suggests using cSEMS over uSEMS. If malignancy has not been histopathologically confirmed, the ASGE recommends against the use of uSEMS. Finally, in patients with unresectable pancreatic cancer and abdominal pain, the ASGE suggests the use of CPN as an adjunct for the treatment of abdominal pain. This document outlines the process, analyses, and decision approaches used to reach the final recommendations and represents the official ASGE recommendations on the above topics.
这是美国胃肠内镜学会（ASGE）的临床实践指南，为内镜在胰腺肿块的诊断和治疗中的作用提供了循证方法。本文件采用推荐评估、制定和评估框架制定，涉及针的选择（细针活检[FNB]针与 FNA 针）、针的口径（22 号与 25 号针）、FNB 针类型（新型或现代[叉尖和 Franseen]与替代 FNB 针设计）和样本处理（即时现场评估[ROSE]与无 ROSE）。此外，本指南还涉及支架的选择（自膨式金属支架[SEMS]与塑料支架）、SEMS 类型（覆盖[CSEMS]与未覆盖[uSEMS]）和疼痛管理（腹腔神经丛松解术[CPN]与药物镇痛治疗）。在接受超声内镜引导下组织采集（EUS-TA）的胰腺实性肿块患者中，ASGE 建议使用 FNB 针而非 FNA 针。关于针的口径，ASGE 建议使用 22 号针而非 25 号针。在使用 FNB 针时，ASGE 建议使用叉尖或 Franseen 针而非替代 FNB 针设计。获得样本后，ASGE 建议在初次 EUS-TA 胰腺实性肿块患者中不常规使用 ROSE。在接受经内镜逆行胰胆管造影术（ERCP）引流的远端恶性胆道梗阻患者中，ASGE 建议使用 SEMS 而非塑料支架。在接受 SEMS 放置的已确诊恶性肿瘤患者中，ASGE 建议使用 CSEMS 而非 uSEMS。如果未通过组织病理学确认恶性肿瘤，ASGE 建议不使用 uSEMS。最后，在无法切除的胰腺癌和腹痛患者中，ASGE 建议使用 CPN 作为腹痛治疗的辅助手段。本文件概述了达成最终建议所使用的过程、分析和决策方法，代表了 ASGE 对上述主题的正式建议。
