S622 Methodological Quality of Clinical Practice Guidelines for the Management of Antithrombotic Agents in Patients Undergoing GI Endoscopy: A Systematic Critical Appraisal Using the AGREE II Tool
Bibliographic record
Abstract
Introduction: Several published clinical practice guidelines (CPGs) exist for the management of antithrombotic agents in patients undergoing GI endoscopy. However, to date, the quality of such CPGs has not been systematically appraised. The goal of this study was to identify and evaluate the quality of CPGs for the management of antithrombotic agents in peri endoscopic period published within last 6 years. Methods: A systematic search of PubMed and Embase database was performed to identify eligible CPGs. Any CPGs published between January 1, 2016 and April 14, 2022 addressing management of antithrombotic agents in patients undergoing GI endoscopy were eligible. The Canadian Agency for Drugs and Technologies in Health (CADTH) broad filter for the CPG terms was used since it is the most sensitive filter. The quality of the CPGs was independently assessed by five reviewers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Domain scores were considered of sufficient quality when >60% and of good quality when >80%. Results: The search yielded 343 citations of which 7 were CPGs and included for the critical appraisal (Table) (one CPG was published in two journals). Five CPGs were published by the gastroenterology associations in Europe (n=2) and Asia (n=3) and two in the United States. The overall median score for the AGREE II domains was 100% for scope and purpose, 72% for stakeholder involvement, 86% for rigor of development, 100% for clarity of presentation, 29% for applicability and 89% for editorial independence. Table presents scores for the AGREE II domains for each included CPG. Conclusion: The findings from our study show that the overall methodological quality of the CPGs for the management of antithrombotic agents in patients undergoing GI endoscopic procedures varies across various domains. Only one CPG included patient representatives in the CPG development process. There is a significant scope for improvement for methodological rigor and the applicability. Table 1. - Clinical practice guidelines included in the critical appraisal using AGREE II instrument. Authors Title Journal AGREE II scores [%] Scope and purpose Stakeholder involvement Rigor of development Clarity of presentation Applicability Editorial independence Overall Acosta et al. The management of antithrombotic agents for patients undergoing GI endoscopy Gastrointest Endosc 2016 Jan;83(1):3-16. doi: 10.1016/j.gie.2015.09.035. 100% 29% 64% 100% 14% 57% 64% Kato et al. Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment: 2017 Appendix on Anticoagulants Including Direct Oral Anticoagulants Dig Endosc. 2018 Jul;30(4):433-440. doi: 10.1111/den.13184. 100% 57% 64% 86% 29% 79% 61% Chan et al. Management of patients on antithrombotic agents undergoing emergency and elective endoscopy: joint Asian Pacific Association of Gastroenterology (APAGE) and Asian Pacific Society for Digestive Endoscopy (APSDE) practice guidelines Gut 2018 Mar;67(3):405-417. doi: 10.1136/gutjnl-2017-315131 100% 86% 79% 100% 14% 100% 73% Farcas et al. Gastrointestinal endoscopy in patients on direct oral anticoagulants. A consensus paper of the Romanian Society of Gastroenterology and Hepatology J Gastrointestin Liver Dis. 2018 Jun;27(2):179-187. doi: 10.15403/jgld.2014.1121.272.end. 100% 57% 71% 71% 29% 86% 61% Lim et al. Clinical Practice Guideline for the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy Clin Endosc. 2020 Nov;53(6):663-677. doi: 10.5946/ce.2020.192 100% 86% 100% 100% 29% 100% 85% Veitch et al. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update Endoscopy. 2021 Sep;53(9):947-969. doi: 10.1055/a-1547-2282 100% 100% 100% 100% 43% 100% 90% Abraham et al. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period 1. J Can Assoc Gastroenterol.2022 5(2):100-101. doi: 10.1093/jcag/gwac010.2. Am J Gastroenterol 2022 117(4):542-558. doi:10.14309/ajg.0000000000001627. 100% 100% 100% 100% 57% 93% 83%
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.337 | 0.673 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.012 | 0.012 |
| Bibliometrics | 0.031 | 0.025 |
| Science and technology studies | 0.003 | 0.005 |
| Scholarly communication | 0.007 | 0.005 |
| Open science | 0.004 | 0.005 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".