Methodological Quality of Clinical Practice Guidelines in Barrett's Esophagus: A Systematic Critical Appraisal Using the AGREE II Tool

Introduction: There have been multiple clinical practice guidelines (CPGs) addressing screening, diagnosis and treatment and surveillance of Barrett’s esophagus (BE). The most recent critical appraisal of CPGs between 2005 and 2013 was done by Feuerstein et al in 2016. However, since then, the American Society of Gastrointestinal Endoscopy (ASGE) and the American College of Gastroenterology (ACG) have published updates on guideline recommendations for BE in 2019 and 2022, respectively. Therefore, the purpose of this systematic review is to assess the methodological quality of CPGs in the management of BE over the past 7 years. Methods: A comprehensive search of EMBASE and PubMed was conducted to identify eligible CPGs from inception until February 10, 2023 which describe the management of BE. Due to being the most sensitive filter, the Canadian Agency for Drugs and Technologies broad filter was utilized. The quality of the CPGs was independently assessed and evaluated by 2 reviewers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument, with domain scores showing good quality being >80% and of sufficient quality when >60%. Results: The search yielded 585 citations of which, 5 were CPGs included for this appraisal. Three of the CPGs were published by gastroenterology groups in the United States and 2 in Europe. The overall median score for the AGREE II domain was 93% for scope and purpose, 79% for stakeholder involvement, 82% for rigor of development, 93%% for clarity of presentation, 79% for applicability, 82% for editorial independence and 78% for overall assessment. Conclusion: The findings from our study show that there is overall variability in the methodological quality of the CPGs for the management of BE varies across different domains. The application of the AGREE II tool can help CPG developers in improving the methodological rigor and applicability of CPGs.