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.
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.
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.
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.
Surgical endoscopy. 2023 Dec 26 [Epub ahead of print]
Adriana Margarita Rey Rubiano, Laura Yuriko González-Teshima, Lázaro Arango, Camilo Blanco-Avellaneda, Jhon Jaime Carvajal Gutiérrez, Rodrigo Castaño-Llano, Martin Alonso Gómez Zuleta, Carlos González, Arecio Peñaloza-Ramírez, Raúl Pinilla Morales, Renzo Pinto Carta, Héctor Adolfo Polanía Liscano, Reinaldo Andrés Rincón Sánchez, Mauricio Sepúlveda Copete, Rómulo Vargas-Rubio, Camilo Andrés Avendaño Capriles, Andrés Mauricio García-Sierra, Juan José Yepes-Nuñez
School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia., Department of Clinical Surgical Gastroenterology, University of Caldas, Manizales, Caldas, Colombia. ., Department of Gastrointestinal Surgery and Digestive Endoscopy, Pontificia Universidad Javeriana, Bogotá, D.C, Colombia., Department of Gastroenterology, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia., Department of Gastroenterology, Universidad de Antioquia, Medellín, Antioquia, Colombia., Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia., Department of Gastroenterology and Digestive Endoscopy, Clínica Reina Sofia, Bogotá, D.C., Colombia., Department of Gastroenterology, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia., Department of Gastroenterology and Oncological Digestive Endoscopy, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia., Colombian Association of Digestive Endoscopy, Bogotá, D.C., Colombia., Department of Gastroenterology, Universidad Surcolombiana, Neiva, Huila, Colombia., Department of Internal Medicine and Gastroenterology, Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogotá, D.C., Colombia., Department of Gastroenterology, Hospital Universitario de San Ignacio, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia., School of Medicine, Universidad del Norte, Barranquilla, Colombia., School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia. .