Network meta-analysis as a tool in clinical practice guidelines

In this issue, the European Association for Endoscopic Surgery (EAES) and its Guidelines Subcommittee report on a rapid guideline for the management of choledocholithiasis [1]. Rapid guidelines or rapid recommendations are short guidelines, addressing one up to a few prioritized clinical questions. With rapid guidelines, eforts are invested in the rigor of development, both at the level of evidence retrieval and appraisal, as well as in the process of generating recommendations based on this evidence. Through a structured approach and in line with predefned methodological standards, an international, interdisciplinary panel provided a weak recommendation in favor of preoperative or intraoperative endoscopic retrograde cholangiopancreatography (ERCP), or laparoscopic common bile duct exploration (LCBDE). A weak or conditional recommendation means that most patients would opt for the proposed intervention after informed decision making, and only a minority would not. For healthcare professionals and policy makers, it means that decision aids are likely needed to help individual patients make decisions consistent with their values and preferences, depending on the setting, resources, surgical expertise, and other parameters.