title: Evaluation of the quality of clinical practice guidelines for the management of esophageal or gastric variceal bleeding.
abstract: METHODS
  Clinical practice guidelines (CPGs) should provide healthcare practitioners with the best possible evidence. Their quality, however, is often suboptimal. An evaluation of CPGs for the treatment of esophageal or gastric variceal bleeding (VB) has not been performed to date.
  
  
  OBJECTIVE
  The aim of this study was to identify and evaluate the quality of CPGs for esophageal or gastric VB.
  
  
  METHODS
  We performed a systematic search of the scientific literature published up to July 2012 to identify and select CPGs related to the management of esophageal or gastric VB. Three independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) instrument. Standardized scores were calculated for the six domains of each instrument, and the overall agreement among reviewers was assessed on the basis of the intraclass correlation coefficient.
  
  
  RESULTS
  Of a total of 23 CPGs identified, 10 were selected. Intraobserver agreement was good (overall intraclass correlation coefficient of 0.956, 95% confidence interval 0.958-0.973). The overall quality of the guidelines varied from low to moderate. Stratified by domains, the quality was good to acceptable in three domains: 'scope and purpose' (78.1%, median 82.3, range 46-100); 'clarity and presentation' (87.2%, median 91.6, range 67-98); and 'editorial independence' (64.1%, median 61.1, range 22-94), but with deficiencies in another three: 'rigor of development' (47.6%, range 28-94), 'stakeholder involvement' (47.5%, median 37, range 18-98) and 'applicability' (25.9% median 13.2, range 1-83). In the overall evaluation, two guidelines were considered 'highly recommended', three, 'recommended with modifications', and five, 'not recommended'. There was a significant improvement in quality over time.
  
  
  CONCLUSIONS
  The overall quality of CPGs for the management of esophageal or gastric VB has improved over time. Although the overall quality was not optimal, two guidelines achieved an excellent rating. A summary of recommendations is provided.
authors.affiliation: aDepartment of Medicine, Research, Capacitation and Management Centre for Evidence-Based Health (CIGES), La Frontera University, Temuco, Chile bIberoamerican Cochrane Centre, Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain cDivision of Gastroenterology and Hepatology, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Eddy
authors.initials: E
authors.lastname: Ríos
authors.forename: Pamela
authors.initials: P
authors.lastname: Serón
authors.forename: Fernando
authors.initials: F
authors.lastname: Lanas
authors.forename: Xavier
authors.initials: X
authors.lastname: Bonfill
authors.forename: Eamonn M M
authors.initials: EM
authors.lastname: Quigley
authors.forename: Pablo
authors.initials: P
authors.lastname: Alonso-Coello
mesh_terms: D032921:Consensus; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000592:standards; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques / Q000592:standards*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D016896:Treatment Outcome