title: Quality assessment of the guidelines on cystic neoplasms of the pancreas.
abstract: BACKGROUND
  Though cystic pancreatic neoplasms (CPNs) are being increasingly detected, their evaluation and management are still debated and have lead to publication of multiple guidelines for diagnostic work-up, indications for resection, and non-operative management with follow-up strategies of CPNs.
  
  
  OBJECTIVE
  To analyze available guidelines in order to evaluate their overall quality and clinical applicability, indications for surgical resection and its extent, modalities and timing of follow-up when non-operative management is indicated.
  
  
  METHODS
  After a systematic search of the English literature, we selected eight guidelines for assessment according to the Appraisal of Guidelines, Research and Evaluation in Europe (AGREE) II instrument.
  
  
  RESULTS
  One guideline received the lower AGREE score regarding the "scope and purpose", "rigor of development" and "clarity and presentation" domains, whereas one received the best score for "stakeholder involvement" domain. No differences were found among different guidelines regarding the "applicability". The overall quality assessment score showed that only two guidelines were significantly lower than the others. According to the practical utilization recommendation score, four guidelines were considered as having full applicability in clinical practice.
  
  
  CONCLUSIONS
  Existing guidelines provide adequate guidance, at least with the present knowledge, for the management of cystic pancreatic lesions; however, not any one was satisfactory to all aspects related to the management of CPN. An update of the existing guidelines should be considered if and when more evidence-based data are available.
authors.affiliation: Division of Pancreatic Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
authors.affiliation: Division of Pancreatic Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Crippa
authors.affiliation: Pancreas Interest Group, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Suresh
authors.initials: S
authors.lastname: Chari
authors.affiliation: Department of Surgery, Trinity College, Dublin, Ireland.
authors.forename: Kevin
authors.initials: K
authors.lastname: Conlon
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, Hospital Beaujon, APHP, Clichy Cedex, Faculté Denis Diderot, DHU Unity, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Levy
authors.affiliation: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, Ludwig-Maximilian University of Munich, Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.affiliation: Department of Surgery and The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.affiliation: Pancreas Unit, Department of Digestive System, Sant'Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy. Electronic address: raffaele.pezzilli@aosp.bo.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pezzilli
authors.affiliation: Pancreas and Biliary Program, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Carlos Fernandez-Del
authors.initials: CF
authors.lastname: Castillo
mesh_terms: D006801:Humans; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011785:Quality Assurance, Health Care
keywords: ADAPTE method; AGREE instrument; Diagnosis; Follow-up; Mucinous cystic neoplasm; Pancreatic cystic lesions