Clinical practice guideline on the use of single-operator cholangioscopy in the diagnosis of indeterminate biliary stricture and the treatment of difficult biliary stones
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Published:2023-12-26
Issue:2
Volume:38
Page:499-510
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ISSN:0930-2794
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Container-title:Surgical Endoscopy
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language:en
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Short-container-title:Surg Endosc
Author:
Rey Rubiano Adriana Margarita, González-Teshima Laura Yuriko, Arango Lázaro, Blanco-Avellaneda Camilo, Carvajal Gutiérrez Jhon Jaime, Castaño-Llano Rodrigo, Gómez Zuleta Martin Alonso, González Carlos, Peñaloza-Ramírez Arecio, Pinilla Morales Raúl, Pinto Carta Renzo, Polanía Liscano Héctor Adolfo, Rincón Sánchez Reinaldo Andrés, Sepúlveda Copete Mauricio, Vargas-Rubio Rómulo, Avendaño Capriles Camilo Andrés, García-Sierra Andrés Mauricio, Yepes-Nuñez Juan JoséORCID
Abstract
Abstract
Background and aims
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.
Conclusion
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.
Funder
Colombian Association of Digestive Endoscopy University of the Andes
Publisher
Springer Science and Business Media LLC
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