Expert consensus on endoscopic papillectomy using a Delphi process

Jeska A. Fritzsche, Paul Fockens, Marc Barthet, Marco J. Bruno, David L. Carr-Locke, Guido Costamagna, Gregory A. Coté, Pierre H. Deprez, Marc Giovannini, Gregory B. Haber, Robert H. Hawes, Jong Jin Hyun, Takao Itoi, Eisuke Iwasaki, Leena Kylänpaä, Horst Neuhaus, Jeong Youp Park, D. Nageshwar Reddy, Arata Sakai, Michael J. BourkeRogier P. Voermans*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background and Aims: Consensus regarding an optimal algorithm for endoscopic treatment of papillary adenomas has not been established. We aimed to assess the existing degree of consensus among international experts and develop further concordance by means of a Delphi process. Methods: Fifty-two international experts in the field of endoscopic papillectomy were invited to participate. Data were collected between August and December 2019 using an online survey platform. Three rounds were conducted. Consensus was defined as ≥70% agreement. Results: Sixteen experts (31%) completed the full process, and consensus was achieved on 47 of the final 79 statements (59%). Diagnostic workup should include at least an upper endoscopy using a duodenoscope (100%) and biopsy sampling (94%). There should be selected use of additional abdominal imaging (75%-81%). Patients with (suspected) papillary malignancy or over 1 cm intraductal extension should be referred for surgical resection (76%). To prevent pancreatitis, rectal nonsteroidal anti-inflammatory drugs should be administered before resection (82%) and a pancreatic stent should be placed (100%). A biliary stent is indicated in case of ongoing bleeding from the papillary region (76%) or concerns for a (micro)perforation after resection (88%). Follow-up should be started 3 to 6 months after initial papillectomy and repeated every 6 to 12 months for at least 5 years (75%). Conclusions: This is the first step in developing an international consensus–based algorithm for endoscopic management of papillary adenomas. Surprisingly, in many areas consensus could not be achieved. These aspects should be the focus of future studies.

Original languageEnglish
Pages (from-to)760-773.e18
JournalGastrointestinal Endoscopy
Volume94
Issue number4
DOIs
Publication statusPublished - 1 Oct 2021

Bibliographical note

Funding Information:
DISCLOSURE: The following authors disclosed financial relationships: P. Fockens: Research grants from Boston Scientific; personal fees from Cook Medical, Ethicon Endo-surgery, and Olympus Medical. M. Barthet: Research grant from Boston Scientific. M. J. Bruno: Consultant for Boston Scientific, Cook Medical, and Pentax Medical; financial support from Boston Scientific, Cook Medical, Pentax Medical, InterScope, 3M, and Mylan. D. L. Carr-Locke: Royalty from Steris Corporation; consultant for Boston Scientific. G. Costamagna: Advisory committee and review panel member for Cook Endoscopy and Olympus; research grant from Boston Scientific. G. A. Cot?: Consultant for Boston Scientific and Olympus; research support from Boston Scientific and Kangen Pharmaceuticals; speaker for Abbvie Pharmaceuticals. G. B. Haber: Consultant for Olympus America, Medtronic, Endoscopy Now, Microtech, Boston Scientific, and Fuji Endoscopy. R. H. Hawes: Consultant for Olympus. M. J. Bourke: Research grants from Olympus Medical, Cook Medical, and Boston Scientific. R. P Voermans: Consultant for Boston Scientific; research grant from Boston Scientific; T. Itoi: Research fees from Olympus Medical Systems, Fujifilm, Gadeliusu Medical K.K., and Boston Scientific Japan K.K. All other authors disclosed no financial relationships.

Funding Information:
DISCLOSURE: The following authors disclosed financial relationships: P. Fockens: Research grants from Boston Scientific; personal fees from Cook Medical, Ethicon Endo-surgery, and Olympus Medical. M. Barthet: Research grant from Boston Scientific. M. J. Bruno: Consultant for Boston Scientific, Cook Medical, and Pentax Medical; financial support from Boston Scientific, Cook Medical , Pentax Medical, InterScope, 3M, and Mylan. G. Costamagna: Advisory committee and review panel member for Cook Endoscopy and Olympus; research grant from Boston Scientific. G. A. Coté: Consultant for Boston Scientific and Olympus; research support from Boston Scientific and Kangen Pharmaceuticals; speaker for Abbvie Pharmaceuticals. G. B. Haber: Consultant for Olympus America, Medtronic, Endoscopy Now, Microtech, Boston Scientific, and Fuji Endoscopy. R. H. Hawes: Consultant for Olympus. M. J. Bourke: Research grants from Olympus Medical, Cook Medical, and Boston Scientific. R. P Voermans: Consultant for Boston Scientific; research grant from Boston Scientific; T. Itoi: Research fees from Olympus Medical Systems, Fujifilm, Gadeliusu Medical K.K., and Boston Scientific Japan K.K. All other authors disclosed no financial relationships.

Publisher Copyright:
© 2021 American Society for Gastrointestinal Endoscopy

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