Title: EAES Multidisciplinary Rapid Guideline: Systematic review, meta-analysis, GRADE assessment and evidence-informed recommendations on the surgical management of paraesophageal hernias
Edition: Original
Classification: Rapid advice guideline
Field: Treatment
Countries and regions: Netherlands
Guidelines users: The guideline is targeted at surgeons, gastroenterologists, primary healthcare physicians, policy makers, and patients. A patient version of the manuscript written in lay language will accompany the guideline report.
Evidence classification method: Results of evidence syntheses will be summarized in evidence tables on MAGICapp [MAGICapp. Available in: https://app.magicapp.org/#/guidelines. Accessed July 13, 2022]. The certainty of the evidence will be assessed by the methodologist on the domains of risk of bias, imprecision, indirectness, publication bias and magnitude of effect. Judgements on risk of bias will be considered in the context or relevant GRADE guidance [Schünemann HJ, Cuello C, Akl EA, Mustafa RA, Meerpohl JJ, Thayer K, Morgan RL, Gartlehner G, Kunz R, Katikireddi SV, Sterne J, Higgins JP, Guyatt G; GRADE Working Group. GRADE guidelines: 18. How ROBINS-I and other tools to assess risk of bias in nonrandomized studies should be used to rate the certainty of a body of evidence. J Clin Epidemiol. 2019 Jul;111:105-114. doi: 10.1016/j.jclinepi.2018.01.012. Epub 2018 Feb 9. PMID: 29432858; PMCID: PMC6692166]. Judgements on imprecision will be informed by the summary of decision thresholds set by the panel members and external advisors (see Selecting outcomes of interest and setting minimal important differences). We will explore for any sources of heterogeneity; if heterogeneity can be conceptually explained, we will not downgrade the certainty of evidence for this factor. Evidence to decision framework We will make the evidence summaries, along with supporting material (e.g., risk of bias assessment, primary studies) available to panel members and external advisors at least 2 weeks before the consensus meeting. This will take place in person, and it will involve detailed presentation of the guideline development methodology, addressing any concerns or disagreements by the panel and the external advisors regarding the evidence summaries, and the evidence to decision framework. Separate evidence-to-decision frameworks will be developed for each clinical question. These will involve discussion on: benefits and harms certainty of the evidence values and preferences resources acceptability feasibility equity Under consideration of the evidence-to-decision discussion and relevant judgements, the panel will draft recommendations in line with the GRADE methodology [22]. External advisors will participate in the discussions, but they will not be involved in the judgements on the evidence-to-decision domains [5]. In an online survey and Delphi process after the in-person meeting, panel members will vote on the direction and the strength of the recommendations, and will be able to suggest modifications to the formulation of the recommendations, which must agree with the GRADE methodology to be considered. Consensus will be defined as agreement above 80% among panel members.
Development unit: European Association for Endoscopic Surgery and Other Interventional Techniques
Registration time: 2023-01-23
Registration number: PREPARE-2023CN018
Purpose of the guideline: Paraesophageal hernia is a condition presenting with fairly high prevalence, especially in advanced age. It may be asymptomatic, or present with a wide range of signs and symptoms, such as heartburn, dyspnea, anemia, and pain. The heterogeneous features of paraesophageal hernias suggest that its management should be tailored. There is a number of debated management options, that refer to surgical intervention or ‘wait and watch’ strategy, the use of mesh for augmentation of the hiatus, and the management of the stomach following hernia reduction. There are no recent guidelines on the management of paraesophageal hernias, and previous recommendations may not be pertinent in the light of new evidence [Kohn GP, Price RR, DeMeester SR, Zehetner J, Muensterer OJ, Awad Z, Mittal SK, Richardson WS, Stefanidis D, Fanelli RD; SAGES Guidelines Committee. Guidelines for the management of hiatal hernia. Surg Endosc. 2013 Dec;27(12):4409-28. doi: 10.1007/s00464-013-3173-3. Epub 2013 Sep 10. PMID: 24018762]. A survey of European Association for Endoscopic Surgery members indicated that this topic is prioritized by a substantial proportion of European surgeons [Outcome of the EAES poll to prioritize topics for future guidelines. Available in: https://eaes.eu/wp-content/uploads/2022/05/2022-05-09-poll.pdf. Accessed July 13, 2022]. The aim of this rapid guideline is provide evidence-informed recommendations to assist clinical decision making around the management of paraesophageal hernias, with the objective to improve perioperative and long-term outcomes, including the quality of life.