TABLE 1.
Important consensus statements
| Statement | Agreement | Grading* |
|---|---|---|
| Diagnostic workup | ||
|
| ||
| 1. Gastroduodenoscopy with side-viewing instrument should always be performed before resection. | 100% | D |
|
| ||
| 2. Biopsy sampling should always be performed before resection. | 94% | D |
|
| ||
| 3. Either MRI/MRCP or EUS should be performed in case of a lesion larger than 2 cm and/or in case of cholestatic laboratory features. | 75% | D |
|
| ||
| 4. Either MRI/MRCP or CT should be performed in case of significant weight loss and/or in case of endoscopic signs of malignancy. | 81% | D |
|
| ||
| 5. CT should be performed in case of jaundice. | 75% | D |
|
| ||
| Lesion assessment and staging | ||
|
| ||
| 6. When a lesion shows ulceration, this lesion should be defined as most likely malignant. | 94% | D |
|
| ||
| 7. Patient should be referred for surgical management in the following cases, considering patient is suitable for surgery: | ||
|
| ||
| a. Ingrowth in the PD >1 cm. | 76% | D |
|
| ||
| b. Ingrowth in the CBD >1 cm. | 81% | D |
|
| ||
| 8. If there is ingrowth in the CBD >1 cm, endoscopic papillectomy with radiofrequency ablation can be considered in a patient who is not a surgical candidate because of age and/or comorbidity, considering the lesion seems favorable for endoscopic resection. | 75% | C |
|
| ||
| Technical aspects | ||
|
| ||
| 9. Submucosal injection should only be performed in case of a laterally spreading lesion. | 88% | C |
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| 10. PD stent should be routinely placed to prevent postintervention pancreatitis. | 100% | B |
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| ||
| 11. CBD stent should only be placed on indication, namely | 82% | D |
|
| ||
| a. If there are concerns for a perforation in the papillary region after resection, a fully covered self-expanding metal stent should be placed in the CBD. | 88% | D |
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| ||
| b. In case of bleeding from the papillary region during the procedure. | 76% | D |
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| 12. Biliary sphincterotomy should be performed in case of concomitant bile duct stones and in case drainage is deemed suboptimal. | 81% | D |
|
| ||
| Adverse events and management | ||
|
| ||
| 13. Rectal nonsteroidal anti-inflammatory drugs should be given before resection. | 82% | B |
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| ||
| Follow-up | ||
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| 14. In case initial pathology shows low-grade dysplasia, first follow-up (after removal of possible placed stents) should be performed within 6 months. | 81% | D |
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| 15. In case initial pathology shows high-grade dysplasia, first follow-up (after removal of possible placed stents) should be performed within 3 months. | 94% | D |
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| ||
| 16. Follow-up should be performed for at least 5 years. | 75% | D |
CBD, Common bile duct; CT, computed tomography; EUS, endoscopic ultrasound; MRCP, magnetic resonance cholangiopancreatography; MRI, magnetic resonance imaging; PD, pancreatic duct.
*
Grading: A, level 1a-1b evidence; B, level 2a-3b evidence; C, level 4 evidence; D, level 5 evidence.