The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

Abstract

Aim There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology. Methods Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines. Results All aspects of surgical care for IBD have been included along with 157 recommendations for management. Conclusion These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.

Consensus standards of healthcare for adults and children with inflammatory bowel disease in the UK

“…The Standards complement the recently published BSG and ACPGBI IBD guidelines 19 20. While these guidelines provide the evidence base and detail of current management, the Standards define a high-quality IBD service, including a number of objective measures of quality.…”

“…The IBD Standards 2019 methodology was designed to align with the 2019 British Society of Gastroenterology (BSG) IBD guidelines19 and the 2018 Association of Coloproctology of Great Britain and Ireland (ACPGBI) IBD surgical guidelines 20. In addition, the process considered other relevant professional and NICE guidelines.…”

The Portsmouth protocol for intra‐operative ultrasound of the small bowel in Crohn's disease

“…In view of the chronic nature of CD, patients may require repeated radiological investigations. Where possible, imaging modalities that do not involve ionizing radiation should be used , and USS and, particularly, MRI offer high diagnostic accuracy.…”

“…Trans‐abdominal USS, often performed preoperatively in patients with CD, usually visualizes the terminal ileum, and in expert hands has an accuracy equivalent to MRI within the distal small bowel . However, the proximal ileum and jejunum may not be satisfactorily visualized due to their deeper location and overlying bowel loops and MRI represents the preferred technique for detection of proximal lesions and preoperative assessment . Intra‐operative USS allows the probe to be placed directly on the surface of the small bowel during the surgery, and no adverse events directly resulting from intra‐operative USS have been reported in preliminary studies (or when intra‐operative USS has been used to assess other abdominal organs during minimally invasive surgery ).…”

Comment on ‘The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease’

“…I represent the Patient Liaison Group working with the Association of Coloproctology of Great Britain and Ireland (ACPGBI) particularly on the topic of inflammatory bowel disease (IBD). I took great pleasure in reading through the recently published guidelines .…”