Consensus and controversy among severe pancreatitis surgery guidelines: a guideline evaluation based on the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool

Abstract

The purpose of this study was to systematically evaluate guidelines for surgery in patients with severe pancreatitis and to identify gaps limiting evidence-based medicine practice. A systematic search of databases and related websites was conducted to identify surgical guidelines for patients with severe pancreatitis. The quality of the included guidelines was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. The similarities among key recommendations were compared, and the evidence supporting them was extracted and analysed. Seven surgical guidelines for patients with severe pancreatitis were included. Only two guidelines, those of the World Society of Emergency Surgery (WSES) and the European Society of Gastrointestinal Endoscopy (ESGE), scored more than 60% for overall quality and were worthy of clinical recommendation. We found that the quality of the severe acute pancreatitis surgical guidelines have much room for improvement, especially in the field of application, the participation of stakeholders and editorial independence. The heterogeneity and causes of surgical recommendations were further analysed, and the latest evidence was retrieved. It was found that the surgical guidelines for severe pancreatitis lacked high-quality evidence, some of the recommendations were controversial, and evidence citation was unreasonable. The quality of surgical guidelines for patients with severe pancreatitis varies widely. In the past 5 years, the key recommendations of the surgical guidelines for severe pancreatitis have been somewhat consistent and controversial, and improvement in these existing problems and controversies will be an effective way for developers to upgrade the surgical guidelines for severe pancreatitis.

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“…In the domain "Evidence", the overall reporting proportion was 40%, but the information on the systematic reviews on which the guidance was based (items 11a and 11b) was reported much less frequently. This result is consistent with several other studies that used AGREEII to evaluate Funding and declaration and management of interests the methodological quality of guidelines (36)(37)(38). The item 11b contains multiple aspects: whether existing systematic reviews were used, or new ones conducted, the search strategies and the selection criteria, evaluation of the risk of bias, and updating the reviews.…”

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“…This research has also indicated that having dedicated guideline committees, issuing guidelines regularly (to accumulate experience) and using GRADE were associated with the highest quality in surgical guidelines. These findings are in line with other guideline quality assessment studies 10 . In light of such evidence, it seems desirable to accelerate the implementation of the GRADE approach.…”

“…These findings are in line with other guideline quality assessment studies. 10 In light of such evidence, it seems desirable to accelerate the implementation of the GRADE approach. To increase the number of available GRADE methodologists the Guidelines International Network (GIN) has recently initiated a comprehensive training program.…”

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“…Each domain score was derived from the total score of each item in the standardized domain as follows: (score obtained − lowest possible score)/(highest possible score − lowest possible score) × 100%. A recommendation for each guideline was provided based on the overall score [ 23 ] as follows: not recommended, <30%; recommended with modifications, 30% to 60%; and recommended, >60% [ 23 ] .…”

“…The methodological quality of the recommended program was assessed using the AGREE II tool [22] , which comprises 23 items in six theoretical domains: Editorial independence (Clauses [22][23]. Each item in a single domain is rated on a seven-point Likert scale ranging from one (did not meet criteria) to seven (fully met criteria).…”