EUS-Guided Choledochoduodenostomy With Lumen-Apposing Metal Stents: A Recommendation From an Expert Delphi Consensus.
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Khoury Tawfik, Sbeit Wisam, Fusaroli Pietro, Do-Cong Pham Khanh, Bronswijk Michiel, Mangiavillano Benedetto, Leblanc Sarah, Lakhtakia Sundeep, Jacques Jeremie, Robles-Medranda Carlos, Yuen Bun Teoh Anthony, Vanella Giuseppe, Ilie Orzan Rares, Spadaccini Marco, Tarantino Ilaria, Anderloni Andrea, Hassan Cesare, Siersema Peter, Kahaleh Michel, Fabbri Carlo, Binda Cecilia, Perez-Miranda M, van Wanrooij R L J, Fumex Fabien, Gincul Rodica, Facciorusso Antonio, Van der Merwe Schalk, Arcidiacono Paolo Giorgio, Kunda Rastislav, Crinò Stefano Francesco, Deprez Pierre H, Lisotti Andrea, Napoléon Bertrand
Аннотация
METHODS: Thirty-two international experts in EUS-CDS-L contributed to this Delphi process over two rounds by voting anonymously on 28 statements using a five-point Likert scale. Statements were accepted in the first round or revised in the second round based on an agreement level of ≥ 80%, with a median ≥ 4, and an interquartile range (IQR) ≤ 1.
RESULTS: 28 statements were initially circulated, 2 were removed, and 26 were considered for final consensus. A consensus was achieved for 24 of 26 (92.3%) statements after two voting rounds across the three domains, with the first focusing on indications: (1) the preference for EUS-CDS-L in distal malignant biliary obstruction (DMBO) without gastric outlet obstruction (GOO); (2) the inclusion of EUS-CDS-L as a therapeutic option in benign biliary obstruction, and (3) the performance of EUS-CDS-L in patients scheduled for upfront surgery. A second domain focused on procedural considerations: (1) the preferred cutoff of common bile duct (CBD) diameter for safe EUS-CDS-L, and (2) the lack of evidence for antibiotic prophylaxis, and several technical steps in the recommended deployment process.
CONCLUSION: This modified Delphi consensus provides international expert panel agreement on several key aspects of EUS-CDS-L, while also highlighting areas that require further research.