Commentary to “ACG clinical guideline: diagnosis and management of small bowel bleeding”

Excerpt

The American College of Gastroenterology recently published a “Practice Guidelines” document [1] in which the authors (and the Society) make specific recommendations about the diagnosis and management of suspected small bowel bleeding. The manuscript is divided into several sections that review the definition, clinical importance, etiology, diagnostic assessment, and therapy of small bowel hemorrhage. The discussion of the utilization of diagnostic procedures focuses on the relative merits of endoscopic techniques and imaging tests and, thus, is of significant relevance to radiologists. In issuing their recommendations, the authors conducted a comprehensive literature search and assigned various levels of evidence to each publication they reviewed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system [2]. Based on the level of evidence available, the recommendations regarding the use of diagnostic tests were classified as “strong” if the desirable effects of the procedure were thought to outweigh the undesirable effects and “conditional” if this analysis produced uncertain results. The recommendations regarding the use of endoscopic vs. imaging techniques for diagnosis are the focus of this Commentary. …