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Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel
  1. Anthony Y B Teoh1,
  2. Vinay Dhir2,
  3. Mitsuhiro Kida3,
  4. Ichiro Yasuda4,
  5. Zhen Dong Jin5,
  6. Dong Wan Seo6,
  7. Majid Almadi7,
  8. Tiing Leong Ang8,
  9. Kazuo Hara9,
  10. Ida Hilmi10,
  11. Takao Itoi11,
  12. Sundeep Lakhtakia12,
  13. Koji Matsuda13,
  14. Nonthalee Pausawasdi14,
  15. Rajesh Puri15,
  16. Raymond S Tang16,
  17. Hsiu-Po Wang17,
  18. Ai Ming Yang18,
  19. Robert Hawes19,
  20. Shyam Varadarajulu19,
  21. Kenjiro Yasuda20,
  22. Lawrence Khek Yu Ho21
  1. 1 Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  2. 2 Baldota Institute of Digestive Sciences, Mumbai, Maharashtra, India
  3. 3 Department of Gastroenterology, Kitasato University Hospital, Sagamihara City, Japan
  4. 4 Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
  5. 5 Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
  6. 6 Department of Gastroenterology, Asan Medical Center, Seoul, Republic of Korea
  7. 7 Department of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
  8. 8 Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
  9. 9 Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
  10. 10 Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  11. 11 Department of Gastroenterology, Tokyo Medical University, Tokyo, Japan
  12. 12 Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
  13. 13 St Marianna University School of Medicine, Yokohama City Seibu Hospital, Kawasaki, Japan
  14. 14 Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  15. 15 Department of Gastroenterology, Institute of Digestive and Hepatobiliary Sciences Medanta, The Medicity, Gurgaon, India
  16. 16 Institute of Digestive Disease, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  17. 17 Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
  18. 18 Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng-qu, Beijing, China
  19. 19 Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA
  20. 20 Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
  21. 21 Department of Medicine, National University of Singapore, Singapore
  1. Correspondence to Professor Anthony Y B Teoh, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China; anthonyteoh{at}surgery.cuhk.edu.hk

Abstract

Objectives Interventional endoscopic ultrasonography (EUS) procedures are gaining popularity and the most commonly performed procedures include EUS-guided drainage of pancreatic pseudocyst, EUS-guided biliary drainage, EUS-guided pancreatic duct drainage and EUS-guided celiac plexus ablation. The aim of this paper is to formulate a set of practice guidelines addressing various aspects of the above procedures.

Methods Formulation of the guidelines was based on the best scientific evidence available. The RAND/UCLA appropriateness methodology (RAM) was used. Panellists recruited comprised experts in surgery, interventional EUS, interventional radiology and oncology from 11 countries. Between June 2014 and October 2016, the panellists met in meetings to discuss and vote on the clinical scenarios for each of the interventional EUS procedures in question.

Results A total of 15 statements on EUS-guided drainage of pancreatic pseudocyst, 15 statements on EUS-guided biliary drainage, 12 statements on EUS-guided pancreatic duct drainage and 14 statements on EUS-guided celiac plexus ablation were formulated. The statements addressed the indications for the procedures, technical aspects, pre- and post-procedural management, management of complications, and competency and training in the procedures. All statements except one were found to be appropriate. Randomised studies to address clinical questions in a number of aspects of the procedures are urgently required.

Conclusions The current guidelines on interventional EUS procedures are the first published by an endoscopic society. These guidelines provide an in-depth review of the current evidence and standardise the management of the procedures.

  • endoscopic ultrasonography
  • pancreatic pseudocyst
  • biliary endoscopy
  • pancreatic disease

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Footnotes

  • Contributors AYBT: Concept and design, voting member, data collection and analysis, drafting of the manuscript. VD: Concept and design, voting member, drafting of the manuscript. MK: Concept and design, voting member, drafting of the manuscript. IY: Concept and design, voting member, drafting of the manuscript. ZDJ: Voting member, critical review of the manuscript. DWS: Voting member, critical review of the manuscript. MA: Voting member, critical review of the manuscript. TLA: Voting member, critical review of the manuscript. KH : Voting member, critical review of the manuscript. IH: Voting member, critical review of the manuscript. TI: Voting member, critical review of the manuscript. SL: Voting member, critical review of the manuscript. KM: Voting member, critical review of the manuscript. NP: Voting member, review of the manuscript. RP: Voting member, critical review of the manuscript. RST: Voting member, critical review of the manuscript. H-PW: Voting member, critical review of the manuscript. AMY: Voting member, critical review of the manuscript. RH: Critical review of the manuscript. SV: Critical review of the manuscript. KY: Voting member, critical review of the manuscript. LKYH: Critical review of the manuscript, final approval of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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