학술논문
EAES, SAGES, and ESCP rapid guideline: bowel preparation for minimally invasive colorectal resection.
Document Type
Article
Author
Antoniou, Stavros A.; Huo, Bright; Tzanis, Alexander A.; Koutsiouroumpa, Ourania; Mavridis, Dimitrios; Balla, Andrea; Dore, Suzanne; Kaiser, Andreas M.; Koraki, Eleni; Massey, Lisa; Pellino, Gianluca; Psichogiou, Mina; Sayers, Adele E.; Smart, Neil J.; Sylla, Patricia; Tschudin-Sutter, Sarah; Woodfield, John C.; Carrano, Francesco Maria; Ortenzi, Monica; Morales-Conde, Salvador
Source
Subject
Language
ISSN
1866-6817
Abstract
Background: Variation exists in practice pertaining to bowel preparation before minimally invasive colorectal surgery. A survey of EAES members prioritized this topic to be addressed by a clinical practice guideline. Objective: The aim of the study was to develop evidence-informed clinical practice recommendations on the use of bowel preparation before minimally invasive colorectal surgery, through evidence synthesis and a structured evidence-to-decision framework by an interdisciplinary panel of stakeholders. Methods: This is a collaborative project of EAES, SAGES, and ESCP. We updated a previous systematic review and performed a network meta-analysis of interventions. We appraised the certainty of the evidence for each comparison, using the GRADE and CINeMA methods. A panel of general and colorectal surgeons, infectious diseases specialists, an anesthetist, and a patient representative discussed the evidence in the context of benefits and harms, the certainty of the evidence, acceptability, feasibility, equity, cost, and use of resources, moderated by a GIN-certified master guideline developer and chair. We developed the recommendations in a consensus meeting, followed by a modified Delphi survey. Results: The panel suggests either oral antibiotics alone prior to minimally invasive right colon resection or mechanical bowel preparation (MBP) plus oral antibiotics; MBP plus oral antibiotics prior to minimally invasive left colon and sigmoid resection, and prior to minimally invasive right colon resection when there is an intention to perform intracorporeal anastomosis; and MBP plus oral antibiotics plus enema prior to minimally invasive rectal surgery (conditional recommendations); and recommends MBP plus oral antibiotics prior to minimally invasive colorectal surgery, when there is an intention to localize the lesion intraoperatively (strong recommendation). The full guideline with user-friendly decision aids is available in https://app.magicapp.org/#/guideline/LwvKej. Conclusion: This guideline provides recommendations on bowel preparation prior to minimally invasive colorectal surgery for different procedures, using highest methodological standards, through a structured framework informed by key stakeholders. Guideline registration number PREPARE-2023CN045. [ABSTRACT FROM AUTHOR]