Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel

Teoh AYB 1 , Dhir V 2 , Kida M 3 , Yasuda I 4 , Jin ZD 5 , Seo DW 6 Show all authors , Almadi M 7 , Ang TL 8 , Hara K 9 , Hilmi I 10 , Itoi T 11 , Lakhtakia S 12 , Matsuda K 13 , Pausawasdi N 14 , Puri R 15 , Tang RS 16 , Wang HP 17 , Yang AM 18 , Hawes R 19 , Varadarajulu S 19 , Yasuda K 20 , Ho LKY 21

Affiliations 

  • 1 Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  • 2 Baldota Institute of Digestive Sciences, Mumbai, Maharashtra, India
  • 3 Department of Gastroenterology, Kitasato University Hospital, Sagamihara City, Japan
  • 4 Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
  • 5 Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
  • 6 Department of Gastroenterology, Asan Medical Center, Seoul, Republic of Korea
  • 7 Department of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
  • 8 Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
  • 9 Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
  • 10 Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 11 Department of Gastroenterology, Tokyo Medical University, Tokyo, Japan
  • 12 Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
  • 13 St Marianna University School of Medicine, Yokohama City Seibu Hospital, Kawasaki, Japan
  • 14 Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 15 Department of Gastroenterology, Institute of Digestive and Hepatobiliary Sciences Medanta, The Medicity, Gurgaon, India
  • 16 Institute of Digestive Disease, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  • 17 Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
  • 18 Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng-qu, Beijing, China
  • 19 Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA
  • 20 Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
  • 21 Department of Medicine, National University of Singapore, Singapore
Gut, 2018 Jul;67(7):1209-1228.
PMID: 29463614 DOI: 10.1136/gutjnl-2017-314341

Abstract

OBJECTIVES: Interventional endoscopic ultrasonography (EUS) procedures are gaining popularity and the most commonly performed procedures include EUS-guided drainage of pancreatic pseudocyst, EUS-guided biliary drainage, EUS-guided pancreatic duct drainage and EUS-guided celiac plexus ablation. The aim of this paper is to formulate a set of practice guidelines addressing various aspects of the above procedures.

METHODS: Formulation of the guidelines was based on the best scientific evidence available. The RAND/UCLA appropriateness methodology (RAM) was used. Panellists recruited comprised experts in surgery, interventional EUS, interventional radiology and oncology from 11 countries. Between June 2014 and October 2016, the panellists met in meetings to discuss and vote on the clinical scenarios for each of the interventional EUS procedures in question.

RESULTS: A total of 15 statements on EUS-guided drainage of pancreatic pseudocyst, 15 statements on EUS-guided biliary drainage, 12 statements on EUS-guided pancreatic duct drainage and 14 statements on EUS-guided celiac plexus ablation were formulated. The statements addressed the indications for the procedures, technical aspects, pre- and post-procedural management, management of complications, and competency and training in the procedures. All statements except one were found to be appropriate. Randomised studies to address clinical questions in a number of aspects of the procedures are urgently required.

CONCLUSIONS: The current guidelines on interventional EUS procedures are the first published by an endoscopic society. These guidelines provide an in-depth review of the current evidence and standardise the management of the procedures.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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