Systematic Analysis and Critical Appraisal of the Quality of the Scientific Evidence and Conflicts of Interest in Practice Guidelines (2005–2013) for Barrett’s Esophagus

Feuerstein, Joseph D.; Castillo, Natalia E.; Akbari, Mona; Belkin, Edward; Lewandowski, Jeffrey J.; Hurley, Christine; Lloyd, Samuel; Leffler, Daniel A.; Cheifetz, Adam S.

doi:10.1007/s10620-016-4222-2

Cited by 13 publications

(10 citation statements)

References 41 publications

(61 reference statements)

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“…Nineteen studies relied on author declarations of FCOI, either through surveys sent to the authors 36,41 or through the declaration section of included guidelines or the sponsoring society of the guideline. [10][11][12][13][14][15][16]24,29,31,32,34,[37][38][39][40]43 Eleven studies evaluated conflict of interest using the CMS-OP or other national databases. 8,9,17,18,[25][26][27]30,33,44,45 Seven studies evaluated conflicts of interest through external searches.…”

Section: Identification Of Conflicts Of Interestmentioning

confidence: 99%

Financial Conflicts of Interest in Clinical Practice Guidelines: A Systematic Review

Tabatabavakili

Khan

Scaffidi

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective: To systematically evaluate the prevalence of disclosed and undisclosed financial conflicts of interest (FCOI) among clinical practice guidelines (CPGs). Methods: In this systematic review, we ascertained the prevalence and types of FCOI for CPGs from January 1, 1980, to March 3, 2019. The primary outcome was the prevalence of FCOI among authors of CPGs. FCOI disclosures were compared between medical subspecialties and societies producing CPGs. Results: Among the 37 studies including 14,764 total guideline authors, 45% had at least one FCOI. The prevalence of FCOI per study ranged from 6% to 100%. More authors had FCOI involving general payments (39%) compared with research payments (29%). Oncology, neurology, and gastroenterology had the highest prevalence of FCOI compared with other medical specialties. Among the 8 studies that included the monetary values in US dollars of FCOI, average payments per author ranged from $578 to $242,300. Among the 10 studies that included data on undisclosed FCOI, 32% of authors had undisclosed industry payments. Conclusion: There are numerous FCOI among authors of CPGs, many of which are undisclosed. Our study found a significant difference in FCOI prevalence based on types of FCOI and CPG sponsor society. Additional research is required to quantify the implications of FCOI on clinical judgment and patient care.

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Section: Identification Of Conflicts Of Interestmentioning

confidence: 99%

Financial Conflicts of Interest in Clinical Practice Guidelines: A Systematic Review

Tabatabavakili

Khan

Scaffidi

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…This lack of transparency makes it difficult for readers and users of the guidelines to assess undue influence and bias and, according to several studies, numerous conflicts of interest are evident when information is disseminated. [23][24][25][26][27] However, it is necessary to highlight the effort made by some groups or entities developing CPGs to reduce the possibility of developers having conflicts of interest. This is an effort in which transparency (understood as a way of operating so that the public can see clearly what actions are carried out) and accessibility have been cited as the most important aspects to assess conflict of interest policies in health organizations.…”

Section: Discussionmentioning

confidence: 99%

“…According to the search criteria, there were 9 CPG reviews (Table 2), of which 7 concluded that there is low disclosure rates of conflicts of interest. [23][24][25][26][27][28][29] However, Feuerstein, in different studies and with the support of several researchers, highlights that this type of publication has multiple conflicts of interest. [23][24][25][26][27] The other 2 reviews do not address this issue.…”

Section: Clinical Practice Guidelinesmentioning

confidence: 99%

Evidencia sobre conflictos de intereses en medicina

Mariño

2020

Rev. Fac. Med.

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Introducción. La principal responsabilidad de los médicos es la de actuar en beneficio de los pacientes; sin embargo, existen situaciones en las cuales surgen intereses secundarios que pueden afectar este compromiso y generar conflictos de intereses.Objetivo. Analizar las revisiones sistemáticas y los metaanálisis actualmente disponibles en la literatura sobre el conflicto de intereses en medicina para sintetizar la información al respecto.Materiales y métodos. Se realizó una búsqueda en las bases de datos MEDLINE y LILACS mediante la siguiente estrategia de búsqueda: revisiones sistemáticas y metaanálisis sobre conflictos de intereses en medicina publicados en revistas científicas seriadas; no se aplicaron restricciones de idioma o año de publicación. Los estudios que cumplieron con los criterios de inclusión fueron agrupados según la actividad médica evaluada; además, de cada uno de ellos se extrajo la cantidad y el tipo de estudios y las conclusiones.Resultados. Se seleccionaron 29 publicaciones que se agruparon en estudios basados en artículos de investigación, en guías de práctica clínica, en la práctica clínica, y en publicaciones orientadas a los pacientes.Conclusiones. Los estudios originales incluidos en las revisiones sistemáticas y los metaanálisis analizados en el presente estudio no siempre reportan los conflictos de intereses; sin embargo, cuando estos se mencionan, hay una tendencia a presentar resultados que favorecen el medicamento o la tecnología del patrocinador.

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“…The main problem of all guidelines is the level of evidence of the statements and recommendations proposed. In a systematic analysis using the AGREE II format for practice guidelines evaluation it was found that most of the recommendations for BE guideline were of level B or C for quality evidence and that they failed to meet the AGREE II domains (36). Although the new guidelines are more convergent that the previous ones, there are still many studies to be carried out evaluating the correct management of BE concerning the best technique to be used and avoiding the over or the under-treatment of the patients.…”

Section: Hgd-endoscopic Interventionsmentioning

confidence: 99%

Critical appraisal of guidelines for screening and surveillance of Barrett’s esophagus

Michopoulos¹

2018

Ann. Transl. Med.

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Esophageal adenocarcinoma (EAC) arising on Barrett esophagus (BE) has become the most frequent type of esophageal malignancy in the Western world. BE is a frequent condition but progression to EAC is rare. Scientific societies publish guidelines in order to improve patients' care. However, there are fields where evidence is lacking or there are many controversies. We aimed to spotlight the most important changes, as well as the points of controversy in the recently published guidelines for BE. For most, a length ≥1 cm of a salmon-pink mucosa extending above the eso-gastric junction is required in order to define BE, accompanied with the presence of intestinal metaplasia (IM) at histology. Screening with endoscopy for the general population is not recommended while there is no proof of the efficacy of screening for targeted high risk populations. New techniques permitting a cytologic examination are under evaluation and may change this strategy. The use of high-resolution endoscopes coupled with a careful inspection of the mucosa are required during surveillance of BE. New studies are necessary in order to clarify the real benefit from the use of advanced techniques, such as virtual chromoendoscopy. Length of non-dysplastic BE plays a role for the interval time determination between endoscopies during surveillance. Indefinite for dysplasia and even more low grade dysplasia (LGD) are debatable issues in the matter of BE. There are compelling data suggesting that a definite LGD, defined as a permanent lesion confirmed by a specialist pathologist in BE, has a more dismal prognosis than previously reported and an ablative intervention may be offered in this case. However, most (75-85%) cases with LGD were downstaged in published studies and it remains unknown if in real life, percentages of downstaging are approaching those of studies or there is an over-treatment of pseudo-LGD. Biomarkers such as p53 immunohistochemistry may aid better identification of patients at higher risk. For high grade dysplasia (HGD) visible lesions should be resected with Endoscopic Mucosal Resection (EMR) while flat lesions ablated, for most, nowadays, with radiofrequency ablation (RFA). Endoscopic submucosal dissection (ESD) has not proved superior compared to EMR in BE. It has to be underlined that most studies leading to the new guidelines for BE are not considered of high quality and new guidelines may emerge in the near future.

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Systematic Analysis and Critical Appraisal of the Quality of the Scientific Evidence and Conflicts of Interest in Practice Guidelines (2005–2013) for Barrett’s Esophagus

Abstract: Majority of the BE guideline fail to meet the AGREE II domains, and most of the recommendations are level B or C quality evidence. Further interventions are necessary to improve the overall quality of the guidelines.

Cited by 13 publications

References 41 publications

Financial Conflicts of Interest in Clinical Practice Guidelines: A Systematic Review

Financial Conflicts of Interest in Clinical Practice Guidelines: A Systematic Review

Evidencia sobre conflictos de intereses en medicina

Critical appraisal of guidelines for screening and surveillance of Barrett’s esophagus

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