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News

Clinical practice guidelines for the management of esophageal or gastric variceal bleeding

The latest issue of the European Journal of Gastroenterology & Hepatology evaluates the quality of clinical practice guidelines for the management of esophageal or gastric variceal bleeding.

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Clinical practice guidelines should provide healthcare practitioners with the best possible evidence.

Their quality, however, is often suboptimal.

An evaluation of clinical practice guidelines for the treatment of esophageal or gastric variceal bleeding has not been performed to date.

Dr Eddy Ríos and colleagues identified and evaluated the quality of clinical practice guidelines for esophageal or gastric variceal bleeding.

The team performed a systematic search of the scientific literature published up to 2012 to identify and select clinical practice guidelines related to the management of esophageal or gastric variceal bleeding.

Overall quality of the guidelines varied from low to moderate
European Journal of Gastroenterology & Hepatology

There were 3 independent reviewers that assessed the eligible guidelines using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) instrument.

Standardized scores were calculated for the 6 domains of each instrument, and the overall agreement among reviewers was assessed on the basis of the intraclass correlation coefficient.

Of a total of 23 clinical practice guidelines identified, 10 were selected.

Intraobserver agreement was good.

The research team found that overall quality of the guidelines varied from low to moderate.

Stratified by domains, the quality was good to acceptable in 3 domains: ‘scope and purpose’, ‘clarity and presentation’, and ‘editorial independence’.

However, the team observed deficiencies in another 3 domains: ‘rigor of development’, ‘stakeholder involvement’, and ‘applicability’.

In the overall evaluation, 2 guidelines were considered ‘highly recommended’, 3, ‘recommended with modifications’, and 5, ‘not recommended’.

There was a significant improvement in quality over time.

Dr Ríos' team comments, "The overall quality of clinical practice guidelines for the management of esophageal or gastric variceal bleeding has improved over time."

"Although the overall quality was not optimal, 2 guidelines achieved an excellent rating."

"A summary of recommendations is provided."

Eur J Gastroenterol Hepatol 2014: 26(4): 422-431
03 April 2014

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