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JAMA Network Clinical Guideline Synopsis
June 17, 2020

Review of American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids

Author Affiliations
  • 1Vanderbilt University, Division of General Surgery, Section of Colon and Rectal surgery, Nashville, Tennessee
JAMA Surg. Published online June 17, 2020. doi:10.1001/jamasurg.2020.0788

Symptomatic hemorrhoids represent one of the most common disease processes that affects patients and accounts for more than 2.2 million outpatient visits each year. It is important for physicians to be able to evaluate common anorectal symptoms and correctly diagnose hemorrhoids, rule out more serious conditions such as cancer, and have a clear understanding of the treatment options.

The current set of guidelines represents an update to the guidelines published by the same group in 2011. These guidelines were developed by the American Society of Colon and Rectal Surgeons Clinical Practice Guidelines Committee. Each member disclosed any conflict of interest. The source material was selected, and the quality and evidence base was reviewed by a subcommittee. The subcommittee then developed the treatment guidelines. Subcommittee recommendations were reviewed by the entire committee for further input, and review with the final guidelines was approved by the American Society of Colon and Rectal Surgeons Clinical Guidelines Committee and the American Society of Colon and Rectal Surgeons Executive Council (Table).

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    1 Comment for this article
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    What grading system was used in the review of the ASCRS practice parameters on hemorrhoids
    Johannes Jongen, MD, EBSQ Coloproctology | Proctological Office Kiel, Kiel, Germany
    To the Editor:

    With great interest we read the review by Muldoon (ref. 1), updating the ASCRS guidelines on the management on hemorrhoids. Since we recently reviewed the quality of guidelines on hemorrhoids, published by the ASCRS, the European Society of Coloproctology (ESCP) and the German Society of Coloproctology (DGK), we are aware, that guidelines might be of different quality (ref.2). In the latter review, we evaluated the three guidelines with the AGREE-System (grading varies between lowest possible quality (1) and highest possible quality (7))(ref. 3). Of course all grading systems (the AGREE-system as well) are subjective for individual
    interpretation, therefor we are curious to know, what grading system was used in the table, mentioned in this publication. Were there only two qualifications: poor and good? This might be the reason, that the author rated the ASCRS guideline differently from what we found.

    Best regards

    Johannes Jongen, MD, FEBSQ Coloproctology, IntFASCRS
    Proctological Office Kiel, Kiel, Germany
    Email: j.jongen@gmx.de
    Sven Petersen, MD, PhD
    Dept. of General- and Visceral Surgery, Asklepios Hospital Hamburg Altona, Hamburg, Germany
    COI: JJ participated in the development of the European (ESCP) and and German (DGK) guidelines on hemorrhoids. SP has no disclosures to make.



    1. Muldoon R, Review of American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. JAMA Surg. Published online June 17, 2020. doi:10.1001/jamasurg.2020.0788
    2. Petersen S, Holch P, Jongen J. Leitlinien zur Behandlung des Hämorrhoidalleidens Ein Vergleich. Coloproctology 2020, https://doi.org/10.1007/s00053-019-00418-8
    3. AGREE Collaboration (2003) Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care 12:18–23
    CONFLICT OF INTEREST: I participated in the development of the European (ESCP) and and German (DGK) guidelines on hemorrhoids.
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