Literature search was conducted in English language publications using MEDLINE, EMBASE, and the Cochrane Trials Register

in human subjects. Relevant literature from the Asia–Pacific region was of particular interest. Categorization of evidence, classification of recommendation, and voting schema was modified from the Canadian Task Force on the Periodic Health Examination (Table 1).[10] The first vote was conducted electronically by email, without explanation Sirolimus price or access to the relevant literature. The second vote was conducted electronically after Web-based access to the provided literature. All feedbacks were collated prior to the face-to-face meeting. Face-to-face meeting of the Consensus group was held on June 30 and July 1, 2012, in Pattaya, Chonburi, Sunitinib mw Thailand, to review and discuss the evidence for all statements. All statements were edited and finally

agreed at the concluding plenary session. In addition, some overlapping statements were combined and rewritten before the final vote. Consensus was considered to be achieved when 80% or above of voting members indicated “accept completely” or “accept with some reservation.” A statement was refuted when 80% or above of voting members “reject completely” or “reject with some reservation.” Every accepted statement was then graded to indicate the level of evidence available and the strength of recommendation. Those statements that did not reach consensus were modified to compensate for the rejected reasons and underwent a revote. If the statement still failed to reach the consensus, that statement was dropped from the list.

Discussed points on dropped statements are also reported in the most relevant below accepted statements. Commentaries on statements were written by the chairmen (RR) and the persons assigned to present the statements during the face-to-face meeting. Co-authors were involved in the final editing of the commentaries. 1. The incidence of cholangiocarcinoma (CCA) varies considerably depending on the geographic region due to the variation in risk factors. The highest incidence is reported in Eastern and Southeastern Asia, and the main risk factor in Asian countries is mostly linked to certain liver fluke infestation. Level of agreement: a—100%, b—0%, c—0%, d—0%, e—0% Quality of evidence: II-1 Classification of recommendation: A There are markedly geographic variations in the incidence of CCA worldwide. The incidence of CCA in the West was reported as much lower (1–2 per 100 000) than in certain parts of Asia (5–71 per 100 000).[11] The highest incidence was reported from Northeastern Thailand (71 per 100 000 in men and 31 per 100 000 in women), followed by Eastern China (10 per 100 000 in men and 5 per 100 000 in women)[1] Table 2.