Appraisal of the Current Guidelines for the Management of AIN Using the Appraisal of Guidelines Research and Evaluation II (AGREE II) Instrument

Abstract

Aim

Anal Intraepithelial Neoplasia has been a hot topic in colorectal surgery and many Scientific Societies have produced guidelines for their diagnosis and treatment. This study aims to appraise the quality of the existing guidelines in this field.

Methods

A systematic review of the Literature was conducted in PubMed, EMBASE and Scholar Google databases. Seven authors independently valued the quality of guidelines using the AGREE II instrument.

Results

This study identified and included 9 guidelines of varying quality. The highest scoring guidelines were different considering each domain. NYSDOH ones gained the higher scoring in 2 domains. However, there was considerable variability across the studies and the various domains. The highest scoring domains were domain VI: Editorial Independence (median = 89% across all studies); IV: Clarity of Presentation (median = 61% across all studies) and domain I: Scope & Purpose (median = 59% across all studies). The lowest scores were observed in domain V: Applicability (22%) and domain III: Rigour of Development (29%). Only 2 of the 9 gained unanimous support for their use, whilst 5 guidelines were unanimously declared unsuitable for clinical use. The last 2 guidelines were considered beneficial only for limited purposes.

Conclusions

4 out of the 9 guidelines examined obtained moderate/good scores in various domains of the AGREE II tool. The review of the guidelines highlighted poor attention to stakeholder involvement and scarce care, mainly in the Rigour of development and Applicability of the guidelines. The AGREE II instrument could improve the drafting of new guidelines or help update published ones.