目的:单操作者胆道镜检查(SOC)提供了一种诊断和治疗替代方案,其光学分辨率优于传统技术;然而,这项技术没有标准化的临床实践指南。哥伦比亚消化内镜协会(ACED)的循证指南旨在支持患者,临床医生,和其他人在决定在成人中使用SOC与内窥镜逆行胰胆管造影术(ERCP)相比,诊断不确定的胆道狭窄和处理困难的胆道结石。
方法:ACED创建了一个平衡的多学科指南小组,以最大程度地减少利益冲突带来的潜在偏见。洛斯安第斯大学和哥伦比亚对建议的评估,发展和评估(等级)网络支持指导方针制定过程,更新和执行系统的证据审查。小组根据临床医生和患者的重要性,优先考虑临床问题和结果。使用了等级方法,包括等级证据到决策框架。
结果:在比较SOC与ERCP时,专家组同意一项针对不确定的胆道狭窄的成年患者的建议和一项针对困难的胆道结石的成年患者的建议。
结论:对于不确定的胆道狭窄的成年患者,专家小组有条件地推荐使用狭窄模式表征的SOC,而ERCP采用刷洗和/或活检的敏感性,特异性,和手术成功率结果。对于患有困难的胆道结石的成年患者,小组有条件地建议SOC超过ERCP并进行大球囊扩张乳头。需要对SOC的经济估计和知识翻译评估进行更多研究,以在当地环境中实施SOC干预。
OBJECTIVE: Single-operator cholangioscopy (SOC) offer a diagnostic and therapeutic alternative with an improved optical resolution over conventional techniques; however, there are no standardized clinical practice
guidelines for this technology. This evidence-based
guideline from the Colombian Association of Digestive Endoscopy (ACED) intends to support patients, clinicians, and others in decisions about using in adults the SOC compared to endoscopic retrograde cholangiopancreatography (ERCP), to diagnose indeterminate biliary stricture and to manage difficult biliary stones.
METHODS: ACED created a multidisciplinary
guideline panel balanced to minimize potential bias from conflicts of interest. Universidad de los Andes and the Colombia Grading of Recommendations Assessment, Development and Evaluation (GRADE) Network supported the
guideline-development process, updating and performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The GRADE approach was used, including GRADE Evidence-to-Decision frameworks.
RESULTS: The panel agreed on one recommendation for adult patients with indeterminate biliary strictures and one for adult patients with difficult biliary stones when comparing SOC versus ERCP.
CONCLUSIONS: For adult patients with indeterminate biliary strictures, the panel made a conditional recommendation for SOC with stricture pattern characterization over ERCP with brushing and/or biopsy for sensitivity, specificity, and procedure success rate outcomes. For the adult patients with difficult biliary stones the panel made conditional recommendation for SOC over ERCP with large-balloon dilation of papilla. Additional research is required on economic estimations of SOC and knowledge translation evaluations to implement SOC intervention in local contexts.