This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for the role of endoscopy in the diagnosis and management of pancreatic masses. This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework and addresses needle selection (fine-needle biopsy [FNB] needle vs FNA needle), needle caliber (22-gauge vs 25-gauge needles), FNB needle type (novel or contemporary [fork-tip and Franseen] vs alternative FNB needle designs), and sample processing (rapid on-site evaluation [ROSE] vs no ROSE). In addition, this guideline addresses stent selection (self-expandable metal stents [SEMS] vs plastic stents), SEMS type (covered [cSEMS] vs uncovered [uSEMS]), and pain management (celiac plexus neurolysis [CPN] vs medical analgesic therapy). In patients with solid pancreatic masses undergoing EUS-guided tissue acquisition (EUS-TA), the ASGE recommends FNB needles over FNA needles. With regard to needle caliber, the ASGE suggests 22-gauge over 25-gauge needles. When an FNB needle is used, the ASGE recommends using either a fork-tip or a Franseen needle over alternative FNB needle designs. After a sample has been obtained, the ASGE suggests against the routine use of ROSE in patients undergoing an initial EUS-TA of a solid pancreatic mass. In patients with distal malignant biliary obstruction undergoing drainage with ERCP, the ASGE suggests using SEMS over plastic stents. In patients with proven malignancy undergoing SEMS placement, the ASGE suggests using cSEMS over uSEMS. If malignancy has not been histopathologically confirmed, the ASGE recommends against the use of uSEMS. Finally, in patients with unresectable pancreatic cancer and abdominal pain, the ASGE suggests the use of CPN as an adjunct for the treatment of abdominal pain. This document outlines the process, analyses, and decision approaches used to reach the final recommendations and represents the official ASGE recommendations on the above topics.

中文翻译：

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美国胃肠内镜学会 （American Society for Gastrointestinal Endoscopy） 关于内镜检查在实性胰腺肿块诊断和管理中的作用指南：总结和推荐


美国胃肠内窥镜学会 （ASGE） 的临床实践指南为内窥镜检查在胰腺肿块诊断和管理中的作用提供了一种循证方法。本文件是使用建议分级评估、开发和评估框架开发的，涉及针头选择（细针活检 [FNB] 针与 FNA 针）、针口径（22 号与 25 号针）、FNB 针类型（新颖或现代 [叉尖和 Franseen] 与其他 FNB 针设计）和样品处理（快速现场评估 [ROSE] 与无 ROSE）。此外，本指南还涉及支架选择（自膨式金属支架 [SEMS] 与塑料支架）、SEMS 类型（有盖 [cSEMS] 与无盖 [uSEMS]）和疼痛管理（腹腔神经丛神经松解症 [CPN] 与药物镇痛治疗）。对于接受 EUS 引导组织采集 （EUS-TA） 的实性胰腺肿块患者，ASGE 建议使用 FNB 针而不是 FNA 针。关于针口径，ASGE 建议使用 22 号而不是 25 号针。使用 FNB 针时，ASGE 建议使用叉尖或 Franseen 针，而不是其他 FNB 针设计。获得样本后，ASGE 建议不要在接受实性胰腺肿块初始 EUS-TA 的患者中常规使用 ROSE。对于接受 ERCP 引流的远端恶性胆道梗阻患者，ASGE 建议使用 SEMS 而不是塑料支架。对于接受 SEMS 放置的确诊恶性肿瘤患者，ASGE 建议使用 cSEMS 而不是 uSEMS。如果恶性肿瘤尚未得到组织病理学证实，ASGE 建议不要使用 uSEMS。 最后，对于不可切除的胰腺癌和腹痛患者，ASGE 建议使用 CPN 作为治疗腹痛的辅助手段。本文档概述了用于得出最终建议的流程、分析和决策方法，并代表了 ASGE 关于上述主题的官方建议。