Summary

Extrahepatic abdominal surgery in patients with cirrhosis of the liver represents a growing clinical challenge due to the increasing prevalence of chronic liver disease and improved long-term survival of these patients. The presence of cirrhosis significantly increases the risk of perioperative morbidity and mortality following abdominal surgery. Advances in preoperative risk stratification, surgical techniques, and perioperative care have led to better outcomes, yet integration of these improvements into routine clinical practice is needed. These clinical practice guidelines provide comprehensive recommendations for the assessment and perioperative management of patients with cirrhosis undergoing extrahepatic abdominal surgery. An individualised patient-centred risk assessment by a multidisciplinary team including hepatologists, surgeons, anaesthesiologists, and other support teams is essential.

Introduction

Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), requires meticulous diagnostic and monitoring protocols to optimize patient outcomes. This document synthesizes key advancements and recommendations for clinical indices, endoscopic scoring, imaging, histological assessment, and tools for evaluating IBD disability. Emphasizing validated, reproducible methods aligns with the ongoing evolution of precision medicine in IBD care, including training. The methodology of the guidelines update process is described in part 1.

Abstract

Objectives

Diagnostic imaging of peritoneal metastases in ovarian and colorectal cancer remains pivotal in selecting the most appropriate treatment and balancing clinical benefit with treatment-related morbidity and mortality. To address the challenges related to diagnostic imaging and detecting and reporting peritoneal metastatic spread, a joint guideline was created by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Society of Urogenital Radiology (ESUR), Peritoneal Surface Oncology Group International (PSOGI), and European Association of Nuclear Medicine (EANM).

Methods

A targeted literature search was performed and consensus recommendations were proposed using Delphi questionnaires and a five-point Likert scale.

Results

A total of three Delphi rounds were performed. Consensus was reached on the position of diagnostic imaging for assessment of operability, treatment response monitoring, and follow-up of peritoneal metastases, optimal imaging modality and their technical imaging requirements depending on the indication and how to optimise communication of imaging results by the report and multidisciplinary board discussion. The complete list of recommendations is provided.

Conclusion

These expert consensus statements aim to guide appropriate indications, acquisition, interpretation, and reporting of imaging for operability assessment, treatment response monitoring, and follow-up of peritoneal metastases in ovarian and colorectal cancer patients.

Key Points

Question Staging peritoneal metastases (PM) helps to guide clinical decision-making for colorectal and ovarian cancer patients. How can we optimise the use of imaging techniques to assess PM?

Findings Imaging plays a crucial role in the detection, operability assessment, treatment response monitoring, and follow-up of peritoneal metastases in colorectal and ovarian cancer patients.

Clinical relevance These expert consensus statements aim to guide appropriate indication, acquisition, interpretation, and reporting of imaging for operability assessment, treatment response monitoring, and follow-up of peritoneal metastases in ovarian and colorectal cancer patients.

INTRODUCTION

Diet is gaining recognition amongst clinicians, researchers, and the inflammatory bowel disease [IBD] community as a potential modifier to change the course of the disease. The role of diet in the management of IBD has evolved beyond adjustment for nutritional needs and is now applied as therapy to influence disease activity and complications. With growing recognition of diet, there is a demand for high-quality dietary research to guide practice and consideration on where to best position diet in the treatment paradigm. This has led to the commissioning of this first European Crohn’s and Colitis Organisation [ECCO] consensus on dietary management of IBD, with the goal of providing evidence-based recommendations to guide clinical practice.

ABSTRACT