Endoscopic Ultrasound-guided Gastroenterostomy: An International Consensus on Current and Expanding Indications, Techniques, Periprocedural Care and Institutional Requirements.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Vanella Giuseppe, Neesse Albrecht, Binda Cecilia, van Hooft Jeanin E, Facciorusso Antonio, Perez-Miranda Manuel, Marchegiani Giovanni, Bronswijk Michiel, Spadaccini Marco, Arlt Alexander, Carrozza Lucio, Moutinho-Ribeiro Pedro, Coluccio Chiara, Pavic Tajana, Catena Fausto, Perez-Cuadrado-Robles Enrique, Conti Bellocchi Maria Cristina, van Wanrooij Roy L J, Forti Edoardo, Seicean Andrada, Lisotti Andrea, Maida Marcello, Mauro Aurelio, Van der Merwe Schalk Willem, Mazza Stefano, Pizzicannella Margherita, Rizzo Giacomo Emanuele Maria, Donatelli Gianfranco, Scimeca Daniela, Stigliano Serena, Troncone Edoardo, Anderloni Andrea, Fabbri Carlo, Tarantino Ilaria, Gornals Joan B, Fuccio Lorenzo
Аннотация
METHODS: An international panel of 66 experts (i-EUS) developed statements using a structured modified Delphi process. Literature searches were performed up to 30 April 2025. Comparative PICO-framed questions with extractable evidence underwent structured evidence synthesis and GRADE assessment, whereas procedural, technical, and organizational statements were classified as consensus based. Consensus was predefined as ≥85% agreement.
RESULTS: Of 25 draft statements, 20 reached consensus and 5 did not. Six endorsed statements were GRADE-based and 14 were consensus-based. For malignant gastric outlet obstruction, EUS-GE was recommended over duodenal stenting because of greater durability and fewer reinterventions and suggested over surgical bypass because of comparable efficacy and fewer overall adverse events. Consensus-based statements addressed expert-centre requirements, supervised training, catheter-based target-loop distension, freehand LAMS deployment, fluoroscopy availability, antithrombotic management, refeeding, post-procedural imaging, recurrent obstruction, and misdeployment. Conditional recommendations addressed LAMS diameter selection, selected benign gastric outlet obstruction, EDGE/EDGI in Roux-en-Y gastric bypass, and malignant afferent limb syndrome. No formal recommendation was issued for peritoneal carcinomatosis, routine tracheal intubation, antibiotic prophylaxis, EDEE in non-RYGB anatomy, or EUS-guided colo-enterostomy.
CONCLUSIONS: These i-EUS recommendations provide a practical framework for EUS-GE and related anastomoses in expert settings. The evidence base remains limited, and prospective comparative studies are needed to refine patient selection, training requirements, and long-term outcomes.