目的:2016年,ESPEN发布了成人慢性肠衰竭(CIF)指南。设计了有关成人良性疾病导致的CIF的ESPEN指南的更新版本,以纳入自先前ESPEN指南发布以来的新证据。
方法:使用苏格兰大学间指南网络(SIGN)的分级系统对文献进行分级。建议根据可用的证据水平进行分级,如A(强),B(有条件的),0(弱)和良好实践要点(3GPP)。2016年指南的建议(使用分级系统进行分级)仍然有效,因为没有检索到支持更新的研究,被重新措辞并相应地重新评级。
结果:回顾了2016年指南的建议,特别关注定义,并包括了新的章节来设计关于IF中心的建议,慢性肠皮肤瘘,IF的成本,在怀孕期间照顾CIF患者,患者从儿科中心过渡到成人中心。新准则包括149项建议和16项声明,经ESPEN成员表决通过,在线在2022年7月,并在2022年9月的年度大会期间的会议上。96项建议的建议等级为3GPP(64.4%),0为29(19.5%),B为19(12.7%),A仅占5人(3.4%)。148(99.3%)的共识等级为“强共识”,一项(0.7%)的共识等级为“共识”。声明的共识等级为14(87.5%)的“强烈共识”和2(12.5%)的“共识”。
结论:确认CIF管理需要复杂的技术,多学科和多专业活动,和专业知识,以护理潜在的胃肠道疾病并提供HPN支持。大多数建议都被分级为阵,但几乎所有人都获得了强烈的共识。
In 2016, ESPEN published the guideline for Chronic Intestinal Failure (CIF) in adults. An updated version of ESPEN
guidelines on CIF due to benign disease in adults was devised in order to incorporate new evidence since the publication of the previous ESPEN
guidelines.
The grading system of the Scottish Intercollegiate Guidelines Network (SIGN) was used to grade the literature. Recommendations were graded according to the levels of evidence available as A (strong), B (conditional), 0 (weak) and Good practice points (GPP). The recommendations of the 2016 guideline (graded using the GRADE system) which were still valid, because no studies supporting an update were retrieved, were reworded and re-graded accordingly.
The recommendations of the 2016 guideline were reviewed, particularly focusing on definitions, and new chapters were included to devise recommendations on IF centers, chronic enterocutaneous fistulas, costs of IF, caring for CIF patients during pregnancy, transition of patients from pediatric to adult centers. The new
guideline consist of 149 recommendations and 16 statements which were voted for
consensus by ESPEN members, online in July 2022 and at conference during the annual Congress in September 2022. The Grade of recommendation is GPP for 96 (64.4%) of the recommendations, 0 for 29 (19.5%), B for 19 (12.7%), and A for only five (3.4%). The grade of
consensus is \"strong
consensus\" for 148 (99.3%) and \"
consensus\" for one (0.7%) recommendation. The grade of
consensus for the statements is \"strong
consensus\" for 14 (87.5%) and \"
consensus\" for two (12.5%).
It is confirmed that CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for the underlying gastrointestinal disease and to provide HPN support. Most of the recommendations were graded as GPP, but almost all received a strong consensus.