European Association of Endoscopic Surgery Clinical Practice Guideline Protocol: Evidence-Informed Recommendations on...

Several options exist for the management of acute cholecystitis. However, practice patterns vary widely, and there is a need for high-quality guidance in areas of controversy.

We will develop a clinical practice guideline on the management of patients with Tokyo Grades I-III acute cholecystitis. The guideline will answer the following key questions: 1.Should adult patients with Grades I or II acute cholecystitis receive conservative management or emergent laparoscopic cholecystectomy?2.Should adult patients with Grades II or III acute cholecystitis receive percutaneous drainage or emergent laparoscopic cholecystectomy?3.Should adult patients with Grades II or III acute cholecystitis receive conservative management or emergent laparoscopic cholecystectomy > 72 h from symptom onset? Our systematic review group will undertake multiple systematic reviews to identify articles addressing each key question. Next, we will appraise the certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. An international, expert multidisciplinary panel will then meet to review the evidence and develop recommendations using GRADE's evidence-to-decision framework. This panel will consist of four general surgeons, an interventional radiologist, an intensive care specialist, an anaesthetist, and two patient representatives. Panel members will finalize our recommendations by consensus at an in-person meeting. This guideline will adhere to methodological standards according to GIN, GRADE and AGREE-S.

All participating members will declare their conflicts of interest, which will be addressed prior to guideline development. This clinical practice guideline will be presented at international scientific meetings, online presentations and social media, and published in full in the journal of Surgical Endoscopy & Other Interventional Techniques.