巴西内镜超声检查共识声明II
II Brazilian consensus statement on endoscopic ultrasonography.
作者信息
Maluf-Filho Fauze, de Oliveira Joel Fernandez, Mendonça Ernesto Quaresma, Carbonari Augusto, Maciente Bruno Antônio, Salomão Bruno Chaves, Medrado Bruno Frederico, Dotti Carlos Marcelo, Lopes César Vivian, Braga Cláudia Utsch, M Dutra Daniel Alencar, Retes Felipe, Nakao Frank, de Sousa Giovana Biasia, de Paulo Gustavo Andrade, Ardengh Jose Celso, Dos Santos Juliana Bonfim, Sampaio Luciana Moura, Okawa Luciano, Rossini Lucio, de Brito Cardoso Manoel Carlos, Ribeiro Camunha Marco Antonio, Clarêncio Marcos, Lera Dos Santos Marcos Eduardo, Franco Matheus, Schneider Nutianne Camargo, Mascarenhas Ramiro, Roda Rodrigo, Matuguma Sérgio, Guaraldi Simone, Figueiredo Viviane
机构信息
Participants of the Nucleus of Endoscopy of the Brazilian Society of Digestive Endoscopy (SOBED); Department of Gastroenterology, Endoscopy Unit, Cancer Institute of São Paulo - ICESP, University of São Paulo, São Paulo, Brazil.
Participants of the Nucleus of Endoscopy of the Brazilian Society of Digestive Endoscopy (SOBED), São Paulo, Brazil.
出版信息
Endosc Ultrasound. 2017 Nov-Dec;6(6):359-368. doi: 10.4103/eus.eus_32_17.
BACKGROUND AND OBJECTIVES
At the time of its introduction in the early 80s, endoscopic ultrasonography (EUS) was indicated for diagnostic purposes. Recently, EUS has been employed to assist or to be the main platform of complex therapeutic interventions.
METHODS
From a series of relevant new topics in the literature and based on the need to complement the I Brazilian consensus on EUS, twenty experienced endosonographers identified and reviewed the pertinent literature in databases. The quality of evidence, strength of recommendations, and level of consensus were graded and voted on.
RESULTS
Consensus was reached for eight relevant topics: treatment of gastric varices, staging of nonsmall cell lung cancer, biliary drainage, tissue sampling of subepithelial lesions (SELs), treatment of pancreatic fluid collections, tissue sampling of pancreatic solid lesions, celiac neurolysis, and evaluation of the incidental pancreatic cysts.
CONCLUSIONS
There is a high level of evidence for staging of nonsmall cell lung cancer; biopsy of SELs as the safest method; unilateral and bilateral injection techniques are equivalent for EUS-guided celiac neurolysis, and in patients with visible ganglia, celiac ganglia neurolysis appears to lead to better results. There is a moderate level of evidence for: yield of tissue sampling of pancreatic solid lesions is not influenced by the needle shape, gauge, or employed aspiration technique; EUS-guided and percutaneous biliary drainage present similar clinical success and adverse event rates; plastic and metallic stents are equivalent in the EUS-guided treatment of pancreatic pseudocyst. There is a low level of evidence in the routine use of EUS-guided treatment of gastric varices.
背景与目的
在20世纪80年代初引入时，内镜超声检查（EUS）用于诊断目的。最近，EUS已被用于辅助复杂治疗干预或作为其主要平台。
方法
从文献中的一系列相关新主题出发，并基于补充巴西关于EUS的第一项共识的需要，20位经验丰富的内镜超声医师在数据库中识别并回顾了相关文献。对证据质量、推荐强度和共识水平进行分级并投票。
结果
就八个相关主题达成了共识：胃静脉曲张的治疗、非小细胞肺癌的分期、胆道引流、上皮下病变（SELs）的组织采样、胰液积聚的治疗、胰腺实性病变的组织采样、腹腔神经丛阻滞以及偶然发现的胰腺囊肿的评估。
结论
对于非小细胞肺癌的分期有高水平的证据；SELs活检是最安全的方法；对于EUS引导的腹腔神经丛阻滞，单侧和双侧注射技术等效，并且在有可见神经节的患者中，腹腔神经节阻滞似乎能带来更好的结果。对于以下方面有中等水平的证据：胰腺实性病变组织采样的取材率不受针的形状、规格或采用的抽吸技术影响；EUS引导的和经皮胆道引流的临床成功率和不良事件发生率相似；在EUS引导治疗胰腺假性囊肿中，塑料支架和金属支架等效。在EUS引导治疗胃静脉曲张的常规应用方面证据水平较低。
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