American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the diagnosis and management of solid pancreatic masses: summary and recommendations

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy Pub Date : 2024-11-01 DOI:10.1016/j.gie.2024.06.002

The ASGE Standards of Practice Committee, Jorge D. Machicado MD, MPH , Sunil G. Sheth MD, FASGE , Jean M. Chalhoub MD , Nauzer Forbes MD, MSc, FASGE , Madhav Desai MD, MPH , Saowanee Ngamruengphong MD, FASGE , Georgios I. Papachristou MD, PhD , Vaibhav Sahai MBBS, MS , Ibrahim Nassour MD, MSCS , Wasif Abidi MD, PhD , Omeed Alipour MD , Stuart K. Amateau MD, PhD, FASGE , Nayantara Coelho-Prabhu MD, FASGE , Natalie Cosgrove MD , Sherif E. Elhanafi MD , Larissa L. Fujii-Lau MD , Divyanshoo R. Kohli MD , Neil B. Marya MD , Swati Pawa MD, FASGE , Bashar J. Qumseya MD, MPH, FASGE

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Abstract

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.

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美国消化内镜学会关于内镜在胰腺实体肿块诊断和管理中的作用的指南：摘要和建议。

美国消化内镜学会（American Society for Gastrointestinal Endoscopy，ASGE）的这一临床实践指南为内镜在胰腺肿块诊断和管理中的作用提供了循证方法。本文件采用建议分级评估、发展和评价框架（Grading of Recommendations Assessment, Development and Evaluation framework）制定，涉及针头选择（细针活检针[FNB] vs FNA针）、针头口径（22号针头 vs 25号针头）、FNB针头类型（新型或现代[叉尖和Franseen] 针头 vs 其他FNB针头设计）和样本处理（快速现场评估[ROSE] vs 无ROSE）。此外，该指南还涉及支架选择（自膨胀金属支架 [SEMS] vs 塑料支架）、SEMS 类型（有盖 [cSEMS] vs 无盖 [uSEMS]）和疼痛处理（腹腔神经丛神经溶解术 [CPN] vs 药物镇痛疗法）。对于在 EUS 引导下进行组织采集 (EUS-TA) 的胰腺实性肿块患者，ASGE 建议使用 FNB 针而不是 FNA 针。关于针头口径，ASGE 建议使用 22 号针头而非 25 号针头。在使用 FNB 针时，ASGE 建议使用叉尖针或 Franseen 针，而不是其他设计的 FNB 针。在获得样本后，ASGE 建议对初次接受胰腺实体肿块 EUS-TA 的患者不要常规使用 ROSE。对于接受 ERCP 引流的远端恶性胆道梗阻患者，ASGE 建议使用 SEMS 而不是塑料支架。对于已证实患有恶性肿瘤并接受 SEMS 置入术的患者，ASGE 建议使用 cSEMS 而不是 uSEMS。如果恶性肿瘤未经组织病理学证实，ASGE 建议不要使用 uSEMS。最后，对于无法切除且伴有腹痛的胰腺癌患者，ASGE 建议使用 CPN 作为治疗腹痛的辅助手段。本文件概述了得出最终建议的过程、分析和决策方法，并代表了美国胰腺学会对上述主题的官方建议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.