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UEG Standards and Guidelines

Clinical Practice Guideline

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EAES, SAGES, and ESCP rapid guideline: bowel preparation for minimally invasive colorectal resection

Stavros A. Antoniou

Summary

AI Generated

A collaborative international guideline provides evidence-informed recommendations on bowel preparation protocols for different minimally invasive colorectal surgery procedures, developed through systematic review, network meta-analysis, and structured consensus by an interdisciplinary panel.

For minimally invasive right colon resection, either oral antibiotics alone or mechanical bowel preparation plus oral antibiotics are suggested options, with the combined approach recommended when intracorporeal anastomosis is intended
Mechanical bowel preparation plus oral antibiotics is suggested for minimally invasive left colon and sigmoid resection
For minimally invasive rectal surgery, mechanical bowel preparation plus oral antibiotics plus enema is suggested
When intraoperative lesion localization is intended in minimally invasive colorectal surgery, mechanical bowel preparation plus oral antibiotics is strongly recommended
The guideline was developed by EAES, SAGES, and ESCP using GRADE and CINeMA methods with input from surgeons, infectious disease specialists, an anesthetist, and a patient representative

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Guideline

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

Publisher

European Association for Endoscopic Surgery and other interventional techniques

Guideline

Clinical Practice Guideline

Topics

Digestive Oncology Surgery

Citation

Surg Endosc 37, 9001–9012 (2023)

Published

2023

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UEG Standards and Guidelines

Clinical Practice Guideline

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