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Zabot GP, Cassol OS, Quaresma AB, Gonçalves Filho FDA, Baima JP, Imbrizi M, Rolim ADS, Carmo AMD, Alves Junior AJT, Santos CHMD, Sobrado Junior CW, Miranda EF, Albuquerque ICD, Souza MMD, Kaiser Junior RL, Parra RS, Kotze PG, Saad-Hossne R. SURGICAL MANAGEMENT OF ADULT CROHN'S DISEASE AND ULCERATIVE COLITIS PATIENTS: A CONSENSUS FROM THE BRAZILIAN ORGANIZATION OF CROHN'S DISEASE AND COLITIS (GEDIIB). Arq Gastroenterol 2023; 59:1-19. [PMID: 36995887 DOI: 10.1590/s0004-2803.2022005s1-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/05/2022] [Indexed: 03/31/2023]
Abstract
BACKGROUND Despite optimized medical therapy, contemporary risk of surgery in inflammatory bowel diseases (IBD) after 10 years of diagnosis is 9.2% in patients with ulcerative colitis (UC) and 26.2% in Crohn's disease, (CD) in the biological era. OBJECTIVE This consensus aims to detail guidance to the most appropriate surgical procedures in different IBD scenarios. In addition, it details surgical indications and perioperative management of adult patients with CD and UC. METHODS Our consensus was developed by colorectal surgeons and gastroenterologists representing the Brazilian Study Group of Inflammatory Bowel Diseases (GEDIIB), with the Rapid Review methodology being conducted to support the recommendations/statements. Surgical recommendations were structured and mapped according to the disease phenotypes, surgical indications, and techniques. After structuring the recommendations/statements, the modified Delphi Panel methodology was used to conduct the voting by experts in IBD surgery and gastroenterology. This consisted of three rounds: two using a personalized and anonymous online voting platform and one face-to-face presential meeting. Whenever participants did not agree with specific statements or recommendations, an option to outline possible reasons was offered to enable free-text responses and provide the opportunity for the experts to elaborate or explain disagreement. The consensus of recommendations/statements in each round was considered to have been reached if there was ≥80% agreement. RESULTS AND CONCLUSION This consensus addressed the most relevant information to guide the decision-making process for adequate surgical management of CD and UC. It synthesizes recommendations developed from evidence-based statements and state-of-art knowledge. Surgical recommendations were structured and mapped according to the different disease phenotypes, indications for surgery and perioperative management. Specific focus of our consensus was given to elective and emergency surgical procedures, determining when to indicate surgery and which procedures may be the more appropriate. The consensus is targeted to gastroenterologists and surgeons interested in the treatment and management of adult patients with CD or UC and supports decision-making of healthcare payors, institutional leaders, and/or administrators.
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Affiliation(s)
- Gilmara Pandolfo Zabot
- Hospital Moinhos de Vento e Coloprocto Clínica do Aparelho Digestivo, Porto Alegre, RS, Brasil
| | | | | | | | - Júlio Pinheiro Baima
- Universidade Nove de Julho, Bauru, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil
| | | | | | | | | | | | | | - Eron Fábio Miranda
- Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru; Curitiba, PR, Brasil
| | | | | | | | - Rogerio Serafim Parra
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Paulo Gustavo Kotze
- Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
| | - Rogério Saad-Hossne
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
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