EAES-SAGES clinical practice guideline update: multi-society recommendations on key controversies in the management of diverticular disease.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Huo Bright, Al Khaldi Maher, Shehata Dena, Calabrese Elisa C, Reinke Caroline, Carrano Francesco, Breukink Stephanie, Kaiser Andreas M, Kimble James, Buchenholz Nicole, Marafini Irene, Biffl Walter, Catena Fausto, Frizelle Frank, Doulias Triantafyllos, Tursi Antonio, Miller Sophie, Ntaga Iro, Dourado Justin, Broderick Joe, Lingam Gita, de Sadeleer Anse, Barbera Elizabeth, Yao Xiaomei, Guyatt Gordon, Yiasemidou Marina, Heuvelings Danique, Garfinkle Richard, Abou-Khalil Maria, Slater Bethany J, Antoniou Stavros A, Bouvy Nicole, Sylla Patricia, Francis Nader, Boutros Marylise
Аннотация
METHODS: We performed a systematic review to identify randomized trials and cohort studies addressing our key questions. Informed by an updated evidence synthesis, an international, multidisciplinary panel of gastrointestinal surgeons, gastroenterologists, patient partners, and methodologists applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework during panel consensus meetings to derive recommendations for the management of patients with diverticular disease.
RESULTS: The systematic review identified 27 studies representing very low to moderate certainty evidence. The panel made the following recommendations: 1. In patients with SUDD, we suggest rifaximin or mesalamine over standard supportive care (conditional recommendation); 2. In patients with uncomplicated diverticulitis, we suggest no routine antibiotics (conditional recommendation); 3. In patients with persistent symptoms following an episode of recurrent uncomplicated diverticulitis, we suggest elective resection over observation (conditional recommendation); 4. In patients who have recovered from a first episode of uncomplicated diverticulitis, we suggest no routine follow-up colonoscopy (conditional recommendation); 5. In patients who have recovered from a first episode of diverticulitis complicated by an abscess, we suggest elective resection over surveillance (conditional recommendation). The panel judged that a significant proportion of patients would place a high value in reducing the risk of recurrence at 1 year but also acknowledged the lack of evidence addressing prioritized outcomes including 30-day major complications, need for emergency surgery, stoma-free survival at 1 year, and quality of life at 1 year. Given that patient values and preferences may vary, clinicians are encouraged to apply patient-centered decision-making and discuss the alternatives.
CONCLUSION: This clinical practice guideline update provides evidence-informed recommendations to support patients and clinicians in the management of diverticular disease.