SURGICAL MANAGEMENT OF ADULT CROHN'S DISEASE AND ULCERATIVE COLITIS PATIENTS: A CONSENSUS FROM THE BRAZILIAN ORGANIZATION OF CROHN'S DISEASE AND COLITIS (GEDIIB).

Autor:	Zabot GP; Hospital Moinhos de Vento e Coloprocto Clínica do Aparelho Digestivo, Porto Alegre, RS, Brasil., Cassol OS; Hospital de Clínicas de Passo Fundo, Passo Fundo, RS, Brasil., Quaresma AB; Universidade do Oeste de Santa Catarina, Joaçaba, SC, Brasil., Gonçalves Filho FA; Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil., Baima JP; Universidade Nove de Julho, Bauru, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil., Imbrizi M; Universidade Estadual de Campinas, Campinas, SP, Brasil., Rolim AS; Hospital Santa Marcelina, São Paulo, SP, Brasil., Carmo AMD; Instituto de Clínicas e Endoscopia, Fortaleza, CE, Brasil., Alves Junior AJT; Pontifícia Universidade Católica de Campinas, Clínica Reis Neto, Campinas, SP, Brasil., Santos CHMD; Hospital Universitário Maria Aparecida Pedrossian, Campo Grande, MS, Brasil., Sobrado Junior CW; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil., Miranda EF; Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru; Curitiba, PR, Brasil., Albuquerque IC; Hospital Heliópolis, Serviço de Coloproctologia, São Paulo, SP, Brasil., Souza MM; Hospital Universitário Júlio Müller, Cuiabá, MT, Brasil., Kaiser Junior RL; Kaiser Clínica, São José do Rio Preto, SP, Brasil., Parra RS; Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil., Kotze PG; Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil., Saad-Hossne R; Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil.
Jazyk:	angličtina
Zdroj:	Arquivos de gastroenterologia [Arq Gastroenterol] 2023 Mar 24; Vol. 59 (suppl 1), pp. 1-19. Date of Electronic Publication: 2023 Mar 24 (Print Publication: 2023).
DOI:	10.1590/S0004-2803.2022005S1-01
Abstrakt:	Background: Despite optimized medical therapy, contemporary risk of surgery in inflammatory bowel diseases (IBD) after 10 years of diagnosis is 9.2% in patients with ulcerative colitis (UC) and 26.2% in Crohn's disease, (CD) in the biological era. Objective: This consensus aims to detail guidance to the most appropriate surgical procedures in different IBD scenarios. In addition, it details surgical indications and perioperative management of adult patients with CD and UC. Methods: Our consensus was developed by colorectal surgeons and gastroenterologists representing the Brazilian Study Group of Inflammatory Bowel Diseases (GEDIIB), with the Rapid Review methodology being conducted to support the recommendations/statements. Surgical recommendations were structured and mapped according to the disease phenotypes, surgical indications, and techniques. After structuring the recommendations/statements, the modified Delphi Panel methodology was used to conduct the voting by experts in IBD surgery and gastroenterology. This consisted of three rounds: two using a personalized and anonymous online voting platform and one face-to-face presential meeting. Whenever participants did not agree with specific statements or recommendations, an option to outline possible reasons was offered to enable free-text responses and provide the opportunity for the experts to elaborate or explain disagreement. The consensus of recommendations/statements in each round was considered to have been reached if there was ≥80% agreement. Results and Conclusion: This consensus addressed the most relevant information to guide the decision-making process for adequate surgical management of CD and UC. It synthesizes recommendations developed from evidence-based statements and state-of-art knowledge. Surgical recommendations were structured and mapped according to the different disease phenotypes, indications for surgery and perioperative management. Specific focus of our consensus was given to elective and emergency surgical procedures, determining when to indicate surgery and which procedures may be the more appropriate. The consensus is targeted to gastroenterologists and surgeons interested in the treatment and management of adult patients with CD or UC and supports decision-making of healthcare payors, institutional leaders, and/or administrators.
Databáze:	MEDLINE
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