How good are the current guidelines on endometriosis? 

The authors evaluated the methodological quality of endometriosis guidelines.

Key Points

Highlights:

• This study is the first to systematically appraise the methodological quality and to map the recommendations of endometriosis guidelines.

Key results:

• The etiology and pathogenesis of endometriosis remain poorly understood.
• Treatment strategies vary depending on the disease severity and other characteristics.
• These challenges have resulted in multidirectional research, with difficulties developing accurate diagnostic tests or effective therapeutic interventions.
• This variation limits the comparability of research to inform patient care through evidence synthesis in the context of guideline formation and patient information.
• For an improved patient care, appropriate and rigorous guideline development is highly required.

What’s done here:

• This group evaluated the methodological quality of endometriosis guidelines, mapped their recommendations, and explored the relationships between recommendations and research evidence.
• Ten recommendations (7%) were comparable across guidelines.
• Forty-two recommendations (28%) were not supported by research evidence.
• The European Society of Human Reproduction and Embryology was objectively evaluated as the highest quality guideline.
• There was substantial variation between the supporting evidence presented by individual guidelines for comparable recommendations.

Conclusions:

• There is substantial variation in the recommendations and methodological quality of endometriosis guidelines.
• Future guidelines should be developed concerning high-quality methods, in consultation with key stakeholders, including women with endometriosis, ensuring that their scope can genuinely inform clinical practice and eliminate unwarranted and unjustified variation. 

Lay Summary

The endometriosis was first described in 1860, yet the etiology and pathogenesis remain poorly understood. Treatment strategies vary significantly between disease severity and the symptoms of pain and/or subfertility. These challenges have resulted in multidirectional research, and the comparability of research to inform patient care through evidence synthesis in the context of guideline formation and patient information. Therefore, an appropriate and rigorous guideline development is highly required to improve patient care.

This is the first study to systematically appraise the methodological quality and to map the recommendations of endometriosis guidelines. One hundred and fifty-two different recommendations were made. Only ten recommendations (7%) were comparable across guidelines. Among those guidelines, the European Society of Human Reproduction and Embryology was objectively evaluated as the highest quality guideline (methodological quality score: 88/100). There was substantial variation between the supporting evidence presented by individual guidelines for comparable recommendations. Forty-two recommendations (28%) were not supported by research evidence and no guideline followed the standardized guideline development methods. 

According to this systematical review, this group concluded that there is substantial variation in the recommendations and methodological quality of endometriosis guidelines. Therefore, future guidelines should be developed with reference to high-quality methods in consultation with key stakeholders, including women with endometriosis, ensuring that their scope can truly inform clinical practice and eliminate unwarranted and unjustified variations in clinical practice.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29030896