Tetsuya Mine1, Toshio Morizane2, Yoshiaki Kawaguchi3, Ryukichi Akashi4, Keiji Hanada5, Tetsuhide Ito6, Atsushi Kanno7, Mitsuhiro Kida8, Hiroyuki Miyagawa9, Taketo Yamaguchi10, Toshihiko Mayumi11, Yoshifumi Takeyama12, Tooru Shimosegawa7. 1. Tokai University, School of Medicine, Isehara, Japan. tetsu-m@is.icc.u-tokai.ac.jp. 2. Japan Council for Quality Health Care, Tokyo, Japan. 3. Tokai University, School of Medicine, Isehara, Japan. 4. Kumamoto City Medical Association Health Care Center, Kumamoto, Japan. 5. Onomichi General Hospital, Onomichi, Japan. 6. Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 7. Department of Gastroenterology, Tohoku University, Sendai, Japan. 8. Kitasato University School of Medicine, Sagamihara, Japan. 9. Sapporo-Kosei General Hospital, Sapporo, Japan. 10. Chiba Cancer Center, Chiba, Japan. 11. University of Occupational and Environmental Health, Kitakyushu, Japan. 12. Faculty of Medicine, Kinki University Hospital, Osakasayama, Japan.
Abstract
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERPC) is used for the diagnosis and treatment of pancreatic and biliary diseases. Post-ERCP pancreatitis (PEP) is a complication which needs special care and clinical practice guideline for this morbidity is also needed. METHODS: The key clinical issues of diagnosis and treatment of PEP were listed and checked, and then the clinical questions were formulated. PubMed (MEDLINE) and Ichushi-web (Japanese medical literature) were used as databases. For the study of diagnostic test accuracy, items similar to QUADAS-2, i.e., random selection from a population to which the diagnostic test is applied, blinding of index tests and reference tests, completeness of reference standard, completeness of test implementations, the same timing of tests, and missing data were assessed as well as the indirectness of the study subjects, index tests, reference standard, and outcomes. Grading of recommendations was determined as strong or weak. In clinical practice, the judgment of attending doctors should be more important than recommendations described in clinical practice guidelines. Gastroenterologists are the target users of this clinical practice guideline. General practitioners or general citizens are not supposed to use this guideline. The guideline committee has decided to include wide clinical issues such as etiological information, techniques of ERCP, the diagnosis, treatments, and monitoring of PEP in this guideline. RESULTS: In this concise report, we described ten clinical questions, recommendations, and explanations pertaining to risk factors, diagnosis, prognostic factors, treatments, and preventive interventions in the medical practice for PEP. CONCLUSIONS: We reported here the essence of the clinical practice guideline for PEP.
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERPC) is used for the diagnosis and treatment of pancreatic and biliary diseases. Post-ERCP pancreatitis (PEP) is a complication which needs special care and clinical practice guideline for this morbidity is also needed. METHODS: The key clinical issues of diagnosis and treatment of PEP were listed and checked, and then the clinical questions were formulated. PubMed (MEDLINE) and Ichushi-web (Japanese medical literature) were used as databases. For the study of diagnostic test accuracy, items similar to QUADAS-2, i.e., random selection from a population to which the diagnostic test is applied, blinding of index tests and reference tests, completeness of reference standard, completeness of test implementations, the same timing of tests, and missing data were assessed as well as the indirectness of the study subjects, index tests, reference standard, and outcomes. Grading of recommendations was determined as strong or weak. In clinical practice, the judgment of attending doctors should be more important than recommendations described in clinical practice guidelines. Gastroenterologists are the target users of this clinical practice guideline. General practitioners or general citizens are not supposed to use this guideline. The guideline committee has decided to include wide clinical issues such as etiological information, techniques of ERCP, the diagnosis, treatments, and monitoring of PEP in this guideline. RESULTS: In this concise report, we described ten clinical questions, recommendations, and explanations pertaining to risk factors, diagnosis, prognostic factors, treatments, and preventive interventions in the medical practice for PEP. CONCLUSIONS: We reported here the essence of the clinical practice guideline for PEP.
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