II Brazilian consensus statement on endoscopic ultrasonography

Abstract

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.

Recommendations for Invasive Procedures in Patients With Diseases of the Liver and Biliary Tract: Report of a Joint Meeting of the Brazilian Society of Hepatology (Sbh), Brazilian Society of Digestive Endoscopy (Sobed) and Brazilian Society of Interventional Radiology and Endovascular Surgery (Sobrice)

“…In selected cases, combined endoscopic and percutaneous approach ("rendezvous" technique) can be used to treat difficult cases of both distal and hilar malignant obstructions. Endoscopic ultrasonographyguided biliary drainage (EUSBD) is also an option in cases of ERCP failures with similar success and adverse events rates as compared to percutaneous route (131) . The decision to perform EUSBD will rely on availability and local expertise, preferably after discussion with a multidisciplinary team.…”

Endoscopic Ultrasound-Guided Celiac Plexus Interventions

“…Although these studies demonstrate significantly better short-term pain relief with the direct ganglia injection approach, data referring to the long-term efficacy is still lacking, and the procedural technique is yet to be standardized. Although some authors did not show significant differences in pain relief between CGN and bilateral or broad plexus EUS-CPN [8], according to a Brazilian consensus statement, in patients with clearly visible ganglia, CGN appears to have better efficacy and should be preferable to CPN [27].…”

What should be known prior to performing EUS?

“…Indications, clinical pathways, and techniques used for EUS may vary in different cultural contexts, countries, and EUS centers. [123456789] Practicing EUS endoscopists from various regions across the world contributed to this review and discussed their standard practice with regard to currently available evidence and according to personal preference.…”