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

Summary

Autoimmune hepatitis (AIH) is a chronic liver disease of unknown aetiology which may affect any patient irrespective of age, sex, or ethnicity. At baseline, the clinical spectrum of the disease varies largely from asymptomatic cases to acute liver failure with massive hepatocyte necrosis. The aim of these EASL guidelines is to provide updated guidance on the diagnosis and management of AIH both in adults and children. Updated guidance on the management of patients with variants and specific forms of AIH is also provided, as is detailed guidance on the management of AIH-associated cirrhosis, including surveillance for portal hypertension and hepatocellular carcinoma, as well as liver transplantation in decompensated cirrhosis.

Keywords

Autoimmune hepatitis; Autoantibodies; Variant syndromes; Immunosuppression; Azathioprine; Mycophenolate mofetil

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.

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.

Abstract

Summary

The updated EASL Clinical Practice Guidelines on the management of hepatitis B virus (HBV) infection provide comprehensive, evidence-based recommendations for its management. Spanning ten thematic sections, the guidelines address diagnostics, treatment goals, treatment indications, therapeutic options, hepatocellular carcinoma surveillance, management of special populations, HBV reactivation prophylaxis, post-transplant care, HBV prevention strategies, and finally address open questions and future research directions. Chronic HBV remains a global health challenge, with over 250 million individuals affected and significant mortality due to cirrhosis and hepatocellular carcinoma. These guidelines emphasise the importance of early diagnosis, risk stratification based on viral and host factors, and tailored antiviral therapy. Attention is given to simplified algorithms, vaccination, and screening to support global HBV elimination targets. The guidelines also discuss emerging biomarkers and evolving definitions of functional and partial cure. Developed through literature review, expert consensus, and a Delphi process, the guidelines aim to equip healthcare providers across disciplines with practical tools to optimise HBV care and outcomes worldwide.