European Society of ColoProctology: guideline for haemorrhoidal disease
European Society of ColoProctology: guideline for haemorrhoidal disease
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DOI：
10.1111/codi.14975
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发表时间：
2020-02-17
影响因子：
3.4
通讯作者：
Breukink, S. O.
中科院分区：
文献类型：
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作者：
van Tol, R. R.;Kleijnen, J.;Breukink, S. O.
目的 欧洲结肠直肠病学会项目的目标是建立痔疮疾病 (HD) 的多学科国际指南，并为 HD 患者最有效的（手术）治疗提供指导。方法 开发过程包括六个阶段。在第一阶段，我们定义了指南的范围。患者群体包括患有所有阶段的痔疮的患者。该指南的目标群体是所有治疗痔疮患者的从业人员，此外还有希望获得有关 HD 治疗管理信息的医护人员和患者。该指南需要解决 HD 的诊断和治疗方式。第二阶段包括指南制定小组（GDG）的编制。所有临床成员都需要对痔疮的诊断和治疗有亲和力。此外，还关注临床医生的地理分布。每个 GDG 成员都在其国家中确定了至少一名可以阅读英语的患者来对指南草案发表评论。在第三阶段，采用相反的流程制定了审查问题，首先是根据 GDG 的知识提出可能的建议。在第四阶段，在 MEDLINE (Ovid)、PubMed、Embase (Ovid) 和 Cochrane 系统评价数据库中进行了文献检索。检索的重点是解决每个综述问题的现有系统综述，并以系统综述涵盖的时间范围后发表的其他研究为补充。在第五阶段，所包含论文的数据由外科住院医师 (RT) 提取，并由方法学家 (JK) 和 GDG 进行检查。如果需要，外科住院医师和方法学家使用 Review Manager 更新系统评价的荟萃分析。在第六阶段，GDG 成员根据使用 GRADE 的文献中找到的证据来决定可以提出哪些建议。结果有六个部分：(i) 症状、诊断和分类；(i) 症状、诊断和分类； (ii) 基本治疗； (iii) 门诊程序； (iv) 外科手术； (v) 特殊情况； (vi) 其他手术技术。制定了 34 条建议。 结论 这份国际多学科指南提供了 HD 管理当前知识的最新且基于证据的总结，可作为患者和临床医生的有用指南。
Aim The goal of this European Society of ColoProctology project was to establish a multidisciplinary, international guideline for haemorrhoidal disease (HD) and to provide guidance on the most effective (surgical) treatment for patients with HD.Methods The development process consisted of six phases. In phase one we defined the scope of the guideline. The patient population included patients with all stages of haemorrhoids. The target group for the guideline was all practitioners treating patients with haemorrhoids and, in addition, healthcare workers and patients who desired information regarding the treatment management of HD. The guideline needed to address both the diagnosis of and the therapeutic modalities for HD. Phase two consisted of the compilation of the guideline development group (GDG). All clinical members needed to have affinity with the diagnosis and treatment of haemorrhoids. Further, attention was paid to the geographical distribution of the clinicians. Each GDG member identified at least one patient in their country who could read English to comment on the draft guideline. In phase three review questions were formulated, using a reversed process, starting with possible recommendations based on the GDG's knowledge. In phase four a literature search was performed in MEDLINE (Ovid), PubMed, Embase (Ovid) and the Cochrane Database of Systematic Reviews. The search was focused on existing systematic reviews addressing each review question, supplemented by other studies published after the time frame covered by the systematic reviews. In phase five data of the included papers were extracted by the surgical resident (RT) and checked by the methodologist (JK) and the GDG. If needed, meta-analysis of the systematic reviews was updated by the surgical resident and the methodologist using Review Manager. During phase six the GDG members decided what recommendations could be made based on the evidence found in the literature using GRADE.Results There were six sections: (i) symptoms, diagnosis and classification; (ii) basic treatment; (iii) outpatient procedures; (iv) surgical interventions; (v) special situations; (vi) other surgical techniques. Thirty-four recommendations were formulated.Conclusion This international, multidisciplinary guideline provides an up to date and evidence based summary of the current knowledge of the management of HD and may serve as a useful guide for patients and clinicians.