胆总管结石在胆囊疾病患者中占相当比例。有几个管理选项,包括术前或术中内镜胰胆管造影(ERCP),和腹腔镜胆总管探查术(LCBDE)。
为了发展证据,跨学科,欧洲关于在完整胆囊的情况下处理胆总管结石的建议,临床决定干预胆囊和胆总管结石。
我们更新了LCBDE的系统评价和网络荟萃分析,术前,术中,和术后ERCP。我们使用等级和CINeMA方法形成了证据摘要,和一个普通外科医生小组,胃肠病学家,一名患者代表为GRADE证据决策框架的开发做出了贡献,该框架可在多种干预措施中进行选择。
专家组就第一轮德尔福达成了一致共识。我们建议LCBDE术前,术中,或术后ERCP,当具有手术经验和专业知识时;术中ERCP超过LCBDE,术前或术后ERCP,当这在给定的医疗保健环境中在逻辑上是可行的;术前ERCP超过LCBDE或术后ERCP,术中ERCP不可行且LCBDE经验或专业知识不足(弱推荐)。证据摘要和决策辅助工具可在MAGICapp平台(https://app。magicapp.org/#/guideline/nJ5zyL)。
我们制定了符合最新方法学标准的快速胆总管结石治疗指南。医疗保健专业人员和其他利益相关者可以使用它来告知临床和政策决定。
IPGRP-2022CN170。
Choledocholithiasis presents in a considerable proportion of patients with gallbladder disease. There are several management options, including preoperative or intraoperative endoscopic cholangiopancreatography (ERCP), and laparoscopic common bile duct exploration (LCBDE).
To develop evidence-informed, interdisciplinary, European recommendations on the management of common bile duct stones in the context of intact gallbladder with a clinical decision to intervene to both the gallbladder and the common bile duct stones.
We updated a systematic
review and network meta-analysis of LCBDE, preoperative, intraoperative, and postoperative ERCP. We formed evidence summaries using the GRADE and the CINeMA methodology, and a panel of general surgeons, gastroenterologists, and a patient representative contributed to the development of a GRADE evidence-to-decision framework to select among multiple interventions.
The panel reached unanimous consensus on the first Delphi round. We suggest LCBDE over preoperative, intraoperative, or postoperative ERCP, when surgical experience and expertise are available; intraoperative ERCP over LCBDE, preoperative or postoperative ERCP, when this is logistically feasible in a given healthcare setting; and preoperative ERCP over LCBDE or postoperative ERCP, when intraoperative ERCP is not feasible and there is insufficient experience or expertise with LCBDE (weak recommendation). The evidence summaries and decision aids are available on the platform MAGICapp ( https://app.magicapp.org/#/guideline/nJ5zyL ).
We developed a rapid guideline on the management of common bile duct stones in line with latest methodological standards. It can be used by healthcare professionals and other stakeholders to inform clinical and policy decisions.
IPGRP-2022CN170.