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Evaluation of the quality of clinical practice guidelines for the management of esophageal or gastric variceal bleeding

Setting Clinical practice guidelines (CPGs) should provide healthcare practitioners with the best possible evidence. Their quality, however, is often suboptimal. An evaluation of CPGs for the treatment of esophageal or gastric variceal bleeding (VB) has not been performed to date. Aim The aim of this study was to identify and evaluate the quality of CPGs for esophageal or gastric VB. Methods We performed a systematic search of the scientific literature published up to July 2012 to identify and select CPGs related to the management of esophageal or gastric VB. Three independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) instrument. Standardized scores were calculated for the six domains of each instrument, and the overall agreement among reviewers was assessed on the basis of the intraclass correlation coefficient. Results Of a total of 23 CPGs identified, 10 were selected. Intraobserver agreement was good (overall intraclass correlation coefficient of 0.956, 95% confidence interval 0.958–0.973). The overall quality of the guidelines varied from low to moderate. Stratified by domains, the quality was good to acceptable in three domains: ‘scope and purpose’ (78.1%, median 82.3, range 46–100); ‘clarity and presentation’ (87.2%, median 91.6, range 67–98); and ‘editorial independence’ (64.1%, median 61.1, range 22–94), but with deficiencies in another three: ‘rigor of development’ (47.6%, range 28–94), ‘stakeholder involvement’ (47.5%, median 37, range 18–98) and ‘applicability’ (25.9% median 13.2, range 1–83). In the overall evaluation, two guidelines were considered ‘highly recommended’, three, ‘recommended with modifications’, and five, ‘not recommended’. There was a significant improvement in quality over time. Conclusion The overall quality of CPGs for the management of esophageal or gastric VB has improved over time. Although the overall quality was not optimal, two guidelines achieved an excellent rating. A summary of recommendations is provided.