title: Purpose, use, and preparation of clinical practice guidelines for the management of biliary tract and ampullary carcinomas.
abstract: Apart from periampullary carcinoma, the prognosis of biliary tract carcinomas, including hilar cholangiocarcinoma, extrahepatic biliary tract carcinoma, and gallbladder carcinoma, remains poor. Sophisticated diagnostic skills and treatment methods and their application are naturally required to achieve better treatment results for biliary tract carcinomas. However, it is not too much to say that, due to the paucity of high-level evidence for the management of these carcinomas, medical care by healthcare providers in clinics and at medical institutes throughout the world is currently delivered without common consensus and common standards. The clinical practice guidelines for the management of biliary carcinoma outlined here were produced with the aim that they could be used by physicians involved in the care of biliary tract carcinomas, as indicators that could help them provide their patients with the most appropriate care possible at this time. Also, the guidelines were prepared to provide measures that could assure patients with biliary tract carcinomas of safe medical care. The present guidelines are characterized by their clarification of clinical questions assumed to be often shared by healthcare professionals. For clarity, we divided the contents of the guidelines into eight areas. In each area, clinical questions are presented, together with recommendations of clinical actions in response to the question. As mentioned already, there is a paucity of high-level evidence in this area; therefore, the recommendations are classified into grades, of which there are five: A, strongly recommend performing the clinical action; B, recommend performing the clinical action; C1, the clinical action may be useful, although there is a lack of high-level scientific evidence; C2, clinical action not definitively recommended because of insufficient scientific evidence; D, recommend not performing the clinical action. The grading of the recommendations is based on the determination of the level of evidence in references on which the recommendation is based.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Shuichi
authors.initials: S
authors.lastname: Miyakawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tsukada
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Junji
authors.initials: J
authors.lastname: Furuse
authors.forename: Hiroya
authors.initials: H
authors.lastname: Saito
authors.forename: Toshio
authors.initials: T
authors.lastname: Tsuyuguchi
authors.forename: Fumio
authors.initials: F
authors.lastname: Kimura
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Yoshitomi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nozawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Hodaka
authors.initials: H
authors.lastname: Amano
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
mesh_terms: D014670:Ampulla of Vater; D001661:Biliary Tract Neoplasms / Q000175:diagnosis / Q000628:therapy*; D002277:Carcinoma / Q000175:diagnosis / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D007564:Japan; D011643:Publishing / Q000191:economics / Q000458:organization & administration; D012955:Societies, Medical / Q000592:standards