TABLE 3.
Selection of final round statements that did not reach consensus
| Statement | Agreement |
|---|---|
| Diagnostic workup | |
|
| |
| 1. Either MRI/MRCP or EUS should be performed in every patient before resection. | 63% |
|
| |
| 2. An endoscopic cholangiogram either before or during EP should only be performed if other performed tests are found inconclusive and there is still doubt about the presence of intraductal extension. | 44% |
|
| |
| Technical aspects | |
|
| |
| 3. STSC of the margins should not be performed after EP. | 56% |
|
| |
| 4. STSC can be performed for the margins of the laterally spreading component but not the papillary margins. | 50% |
|
| |
| 5. Pancreatic sphincterotomy after resection should only be performed in case of | |
|
| |
| a. Extension in the pancreatic duct. | 38% |
|
| |
| b. Extension in the pancreatic duct or if drainage is deemed suboptimal. | 44% |
|
| |
| 6. It can be helpful to inject the PD before resection to make it easier to find the PD after resection in case of extension in the pancreatic duct. | 44% |
|
| |
| 7. In case there is bleeding during the procedure, an FCSEMS instead of a plastic stent should be placed in the CBD. | 63% |
|
| |
| 8. In case there are concerns for residual adenomatous tissue in the distal part of the CBD, an FCSEMS should be placed in the CBD. | 31% |
|
| |
| 9. Standard clip closure of the mucosal defect after resection should not be performed. | 38% |
|
| |
| 10. Glucagon or scopulaminebutyl should be provided routinely before resection to reduce the risk of losing the specimen in the GI tract. | 56% |
|
| |
| Adverse events and management | |
|
| |
| 11. Vigorous hydration should be considered in patients without any cardiac comorbidity to further decrease the risk of postintervention pancreatitis. | 63% |
|
| |
| 12. Every patient should be treated with PPI after performing an EP. | 69% |
|
| |
| 13. Patients treated with PPI after resection should be treated for at least 2 weeks. | 69% |
|
| |
| 14. If a bleeding occurs after EP and patient is hemodynamically stable after resuscitation with <1.2 mmol/L drop in hemoglobin | |
|
| |
| a. Reintervention should be performed within 12 hours. | 38% |
|
| |
| b. Conservative treatment (continue or start PPI) is initially indicated. | 63% |
|
| |
| Follow-up | |
|
| |
| 15. Every patient should be admitted for observation after EP for | |
|
| |
| a. At least 24 hours. | 69% |
|
| |
| b. At least 48 hours. | 44% |
CBD, Common bile duct; EP, endoscopic papillectomy; EUS, endoscopic ultrasound; FCSEMS, fully covered self-expanding metal stent; MRCP, magnetic resonance cholangiopancreatography; MRI, magnetic resonance imaging; PD, pancreatic duct; PPI, proton pump inhibitor; STSC, snare tip soft coagulation.