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Enteroscopy in diagnosis and treatment of small bowel bleeding: A Delphi expert consensus
Andrea Sorge1, Luca Elli2, Emanuele Rondonotti3
1Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Insights
This study established a consensus on small bowel bleeding management using a Delphi process. The findings provide clear definitions and a unified strategy for enteroscopy in clinical practice.
Area of Science:
- Gastroenterology
- Endoscopy
- Clinical Practice Guidelines
Background:
- Enteroscopy is crucial for small bowel bleeding management.
- Current guidelines lack specificity and exhibit international inconsistencies.
- Heterogeneity in definitions and practices hinders optimal patient care and research.
Purpose of the Study:
- To achieve consensus on small bowel bleeding definitions.
- To define the role of enteroscopy in managing small bowel bleeding.
- To standardize clinical practice through expert consensus.
Main Methods:
- A Delphi process involving a core group of experts and an expert panel.
- Identification of key topics and drafting of consensus statements.
- Three rounds of voting to achieve agreement on 33 statements.
Main Results:
- 33 statements on small bowel bleeding management were approved.
- Consensus was reached on definitions and the role of enteroscopy.
- The process involved 8 core experts and 9 panel gastroenterologists.
Conclusions:
- The Delphi consensus offers standardized definitions for small bowel bleeding.
- It proposes a unifying strategy for enteroscopy in clinical practice.
- Provides practical guidance for clinicians managing small bowel bleeding.
Background:
Enteroscopy plays an important role in the management of small bowel bleeding. However, current guidelines are not specifically designed for small bowel bleeding and recommendations from different international societies do not always align. Consequently, there is heterogeneity in the definitions of clinical entities, clinical practice policies, and adherence to guidelines among clinicians. This represents an obstacle to providing the best patient care and to obtain homogeneous data for clinical research.
Aims:
The aims of the study were to establish a consensus on the definitions of bleeding entities and on the role of enteroscopy in the management of small bowel bleeding using a Delphi process.
Methods:
A core group of eight experts in enteroscopy identified five main topics of small bowel bleeding management and drafted statements on each topic. An expert panel of nine gastroenterologists participated in three rounds of the Delphi process, together with the core group.
Results:
A total of 33 statements were approved after three rounds of Delphi voting.
Conclusion:
This Delphi consensus proposes clear definitions and a unifying strategy to standardize the management of small bowel bleeding. Furthermore, it provides a useful guide in daily practice for both clinical and technical issues of enteroscopy.
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