EFSUMB Guidelines – Mission accomplished – Seven novel GIUS guidelines and recommendation papers

Author: Prof. Odd Helge Gilja

Transabdominal gastro-intestinal ultrasound (GIUS) is a unique method to examine non-invasively and in physiological condition the intestines including extra-intestinal features such as the splanchnic vessels, mesentery and lymph nodes. Although there is good documentation for the usefulness of GIUS in clinical practice it has only been fully implemented in a few European countries and expert centres. Furthermore, the lack of standardization of the examination technique and guidelines makes education of physicians more challenging.

Therefore, in 2014 EFSUMB Executive Bureau decided to start a new project to develop and publish the first guidelines ever on gastrointestinal ultrasound (GIUS). Over 20 European experts were invited to take part in a Task Force Group (TFG) to establish the new guidelines. The TFG have met physically on several UEGWs and contributed extensively to a post-graduate course on GIUS in Gargnano, Italy in 2016.

Course Directors Giovanni Maconi and Odd Helge Gilja

For each recommendation in the papers, levels of evidence (LoE) and grades of recommendation (GoR) were included to evaluate the clinical role in various applications. These were generated according to the Oxford centre for evidence-based medicine criteria (http://www.cebm.net/oxford-centre-evidencebased-medicine-levels-evidence-march-2009/).

Since many of the themes in these guidelines have not been subjected to systematic studies these recommendations often have a level of evidence 4 or 5, the latter being expert opinion. Accordingly, this document also includes the level of consensus of the members in the GIUS task force group. The manuscript and voting was partly finalized by e-mail communication and by applying a web-based software by Clinical Guideline Services (Clinical Guideline Services (guideline-service.de). Degree of consensus was graded as follows: Strong consensus = > 95 %, broad consensus = 95–76 %, majority consensus 75–50 % and dissent < 50 %.

I would like to take this opportunity to extend my deepest appreciations to all members of the GIUS Task Force Group who with great endurance have contributed over the last 7 years to accomplish this important mission.

The GIUS guideline and clinical recommendation papers are:

1. Nylund K, Maconi G, Hollerweger A, Ripolles T, Pallotta N, Higginson A, Serra C, Dietrich CF, Sporea I, Saftoiu A, Dirks K, Hausken T, Calabrese E, Romanini L, Maaser C, Nuernberg D, Gilja OH. EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound. Ultraschall in Med. 2017 Jun; 38(3): 273–284. English. doi:10.1055/s-0042–115410. Epub 2016 Sep 7. PMID: 27604051.

2. Maconi G, Nylund K, Ripolles T, Calabrese E, Dirks K, Dietrich CF, Hollerweger A, Sporea I, Saftoiu A, Maaser C, Hausken T, Higginson AP, Nürnberg D, Pallotta N, Romanini L, Serra C, Gilja OH. EFSUMB Recommendations and Clinical Guidelines for Intestinal Ultrasound (GIUS) in Inflammatory Bowel Diseases. Ultraschall in Med. 2018 Jun; 39(3): 304–317. English. doi:10.1055/s-0043–125329. Epub 2018 Mar 22. PMID: 29566419.

3. Nuernberg D, Saftoiu A, Barreiros AP, Burmester E, Ivan ET, Clevert DA, Dietrich CF, Gilja OH, Lorentzen T, Maconi G, Mihmanli I, Nolsoe CP, Pfeffer F, Rafaelsen SR, Sparchez Z, Vilmann P, Waage JER. EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound. Ultrasound Int Open. 2019 Jan; 5(1): E34-E51. doi:10.1055/a-0825–6708. Epub 2019 Feb 5. PMID: 30729231; PMCID: PMC6363590.

4. Dirks K, Calabrese E, Dietrich CF, Gilja OH, Hausken T, Higginson A, Hollerweger A, Maconi G, Maaser C, Nuernberg D, Nylund K, Pallotta N, Ripolles T, Romanini L, Saftoiu A, Serra C, Wüstner M, Sporea I. EFSUMB Position Paper: Recommendations for Gastrointestinal Ultrasound (GIUS) in Acute Appendicitis and Diverticulitis. Ultraschall in Med. 2019 Apr; 40(2): 163–175. English. doi:10.1055/a-0824–6952. Epub 2019 Jan 7. PMID: 30616263.

5. Dietrich CF, Hollerweger A, Dirks K, Higginson A, Serra C, Calabrese E, Dong Y, Hausken T, Maconi G, Mihmanli I, Nürnberg D, Nylund K, Pallotta N, Ripollés T, Romanini L, Săftoiu A, Sporea I, Wüstner M, Maaser C, Gilja OH. EFSUMB Gastrointestinal Ultrasound (GIUS) Task Force Group: Celiac sprue and other rare gastrointestinal diseases ultrasound features. Med Ultrason. 2019 Aug 31; 21(3): 299–315. doi:10.11152/mu-2162. PMID: 31476211.

6. Hollerweger A, Maconi G, Ripolles T, Nylund K, Higginson A, Serra C, Dietrich CF, Dirks K, Gilja OH. Gastrointestinal Ultrasound (GIUS) in Intestinal Emergencies – An EFSUMB Position Paper. Ultraschall in Med. 2020 Dec; 41(6): 646–657. English. doi: 10.1055/a-1147–1295. Epub 2020 Apr 20. PMID: 32311749.

7. Maconi M, Hausken T, Dietrich CF, Pallotta N, Sporea I, Nurnberg D, Romanini L, Serra C, Braden B, Sparchez Z, Gilja OH. Gastrointestinal Ultrasound in Functional Disorders of the Gastrointestinal Tract. EFSUMB consensus statement. Ultrasound Int Open 2021. In press.

All these guidelines and more are available on the EFSUMB website www.efsumb.org