Introduction

This is the second European Crohn’s and Colitis Organisation [ECCO] evidence-based consensus on extraintestinal manifestations [EIMs] of inflammatory bowel disease [IBD] and anaemia. Up to 50% of patients with IBD will develop at least one EIM, which may impact each body system; hence they are a source of considerable morbidity, or even mortality in the case of primary sclerosing cholangitis [PSC] or venous thromboembolic events [VTE]. Broadly, EIMs can be categorized as classical, arising from inflammatory pathology at distant sites, the consequences of systemic inflammation and treatment, or wider associations. The underlying pathophysiology of extraintestinal inflammation is not fully understood. Potential driving forces include extension of the immune-mediated response from the inflamed gut to other organs, with shifts in leukocyte trafficking, changes to the intestinal microbiota, and underlying predisposing genetic factors. The systemic consequences of IBD lead to broader associations, including VTEs and anaemia. Whether these are strictly EIMs is of debate, but they are included within this guideline as they incur a considerable health burden to patients with IBD.

Introduction

Inflammatory bowel disease [IBD] has a high incidence and prevalence in young individuals, affecting people in their reproductive years. The diagnosis of IBD raises many questions; these include concerns about sexuality, disease heritability, and the impact of medications and disease activity on fertility, pregnancy outcomes, and lactation. Uncertainty about the health of the offspring may influence patients’ choices in family planning. Therefore, the management of patients who wish to conceive or who are pregnant requires specialised counselling and appropriate management. This involves a multidisciplinary approach and close involvement of the prospective parents under a shared decision-making model. These updated consensus guidelines address these issues and aim to optimise and harmonise pre-conceptional, pregnancy, and post-pregnancy IBD management and counselling.

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.

Keywords: Bowel preparation, Colorectal surgery, Minimally invasive surgery, Laparoscopic surgery, Guidelines

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.

Abstract

Abstract