NDDIC News

NIH Consensus Conferences Home In on ECRP and Hepatitis C

Full consensus statements from two National Institutes of Health (NIH) Consensus Development Conferences have been posted at www.niddk.nih.gov under "Conferences and Workshops." Summary points of the endoscopic retrograde cholangiopancreatography and hepatitis C management conferences follow.

Endoscopic Retrograde Cholangiopancreatography (ERCP) for Diagnosis and Therapy
January 14–16, 2002

• In light of rapid advances in medical imaging technologies, ERCP is evolving into a therapeutic, rather than a diagnostic, tool. Less invasive imaging techniques may eclipse ERCP's value as a tool for diagnosing pancreaticobiliary diseases, but it continues to be useful in treating both benign and malignant diseases of the pancreas and biliary tract.
  
  
• The available evidence supports ERCP's merit in treating symptomatic gallstone disease, common bile duct stones, recurrent pancreatitis, and pancreatic pseudocysts. In addition, ERCP with endoscopic sphincterotomy and stone removal is valuable for patients with jaundice caused by stones in the common bile duct, dilated common bile duct, cholangitis, or acute pancreatitis.
  
  
• ERCP remains the best means for diagnosing suspected ampullary cancers and for patients with pancreatic or biliary cancer who are not candidates for surgery.
  
  
• Performing ERCP can involve substantial risks. The panel stressed the need for appropriate training and expertise, especially for advanced ERCP, and noted that avoiding unnecessary ERCP is the best way to reduce complications such as postprocedure pancreatitis.
  
  
• Improving the quality of clinical investigation in pancreaticobiliary diseases in general, and ERCP in particular, is a critical need. The panel recommended forming a cooperative group to foster multicenter involvement in designing and conducting large clinical trials. The panel advocated randomized, prospective trials to assess both benefits and risks of ERCP compared with other diagnostic and therapeutic interventions for biliary and pancreatic problems.
  
  

Management of Hepatitis C: 2002
June 10–12, 2002

• Despite significant advances in treatment for chronic hepatitis C and a decline in the number of new infections, a fourfold increase in the number of persons with chronic hepatitis C infection is projected over the next decade. This increase is due to unsuspected infection from contaminated blood and blood products before the advent of routine screening in the early 1990s, occupational exposure, and injection drug use.
  
  
• Clinical trials provide persuasive evidence that treating the hepatitis C virus (HCV) with a combination of pegylated interferon and ribavirin produces a considerably better sustained viral response (SVR) than monotherapy or the standard interferon-ribavirin combination. Unfortunately, patients with genotype 1 HCV, who account for 70 to 75 percent of infected persons, require longer therapy and have a lower SVR.
  
  
• Although SVR has not yet been correlated with improved survival because of the need for long-term followup, the absence of detectable HCV provides a significant benefit in terms of resolution of liver injury, reduction of liver fibrosis, and a lower likelihood of HCV reinfection. The best treatments for nonresponders and relapsers are less clear.
  
  
• The panel recommended expanding the scope of patients eligible for treatment to include those who inject drugs, consume alcohol, suffer from comorbid conditions such as depression, or are co-infected with HIV. Similarly, panelists cautioned against excluding children and older adults from treatment and further research.
  
  
• Recommendations for future research include the development of reliable and reproducible cultures, which will advance the understanding of HCV biology and mechanisms of drug resistance and aid vaccine development. The panel urged the establishment of a hepatitis research network to conduct research into the natural history, prevention, and treatment of hepatitis C. Studies to determine the efficacy of alternative medicines are needed as well. The panel also recommended the development of strategies to better prevent, diagnose, and treat the disease in injection drug users and the incarcerated population.
  
  

The NIH Consensus Development Program is managed by the NIH Office of Medical Applications of Research (OMAR). Under this program, OMAR organizes major conferences that produce consensus statements and state-of-the-science statements on controversial issues in medicine important to health care providers, patients, and the general public.

NIH State-of-the-Science and Consensus Statements are prepared by a nonadvocate, non-Federal panel of experts on the basis of (1) presentations given during a 2-day public session by investigators working in areas relevant to the consensus questions, (2) questions and statements from conference attendees during open discussion periods that are part of the public session, and (3) closed deliberations by the panel during the remainder of the second day and the morning of the third. The summary statement reflects the panel's assessment of medical knowledge available at the time the statement was written. It provides a "snapshot in time" of the state of knowledge on the conference topic. The statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.

NIH Publication No. 03–4552
March 2003