The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia

This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this document that updates a previously issued consensus statement and a technology status evaluation report on this topic. 1 In preparing this guideline, a search of the medical literature was performed by using PubMed between January 1975 and May 2015, with the use of the search terms pancreatic AND malignancy, endoscopy, EUS, and ERCP. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When limited or no data existed from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Recommendations for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the documents are drafted. Further controlled clinical studies may be needed to clarify aspects of recommendations contained in this document. This document may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. The recommendations were based on reviewed studies and were graded on the strength of the supporting evidence (Table 1). 2 The strength of individual recommendations is based both on the aggregate evidence quality and an assessment of the anticipated benefits and harms. Weaker recommendations are indicated by phrases such as we suggest, whereas stronger recommendations are typically stated as we recommend. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. It is not a rule and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions in any particular case involve a complex analysis of the patient's condition and available courses of action. Therefore, clinical considerations may lead an endoscopist to take a course of action that varies from these recommendations and suggestions.