ECCO guidelines on inflammatory bowel disease and malignancies

this guideline is the second european crohn’s and colitis organisation [ECCO] evidence-based consensus on inflammatory bowel disease [IBD] and malignancy, and is an update on the guidance published in 2015.1 this edition was designed to address key areas in which the management of IBD may be affected by either the risk of or the presence of malignancy. these include the risk of cancers associated with IBD, the risk of cancers from therapies used to treat IBD, and the management of IBD in a patient with active or recent cancer. this guideline was created according to ecco’s standardised methodology. a panel of 27 experts was selected by the ecco guidelines committee from a competitive pool of applicants. two guidelines committee members, HG and TR, were selected as project coordinators. participating experts were split into four working groups [WG] and a leader was selected for each WG. topics were determined by the project coordinators and WG leaders and split between the four groups as follows: WG1, IBD and risk of malignancy; WG2, Small molecules and malignancy in IBD; WG3, biologics and malignancy in IBD; and WG4, managing IBD in patients with a history of cancer. for each topic, a clinically relevant question was formulated and used to define a population, Intervention, and comparator[s] of interest. these informed a systematic literature search, performed by a professional librarian using pubmed/medline, embase, and the cochrane central databases. abstracts from each literature search were screened by two participants. full texts of potentially relevant abstracts were retrieved and evaluated in full by both authors, who reached agreement on which papers were most relevant to inform the answer to the clinical question. available as supplementary data at ECCO-JCC online. a consensus statement and supporting text were drafted for each topic and posted on an online guidelines platform. two rounds of online voting and revisions took place. during this process, each participant was asked to rank the statement from ‘strongly agree’ to ‘disagree’, with the option of abstaining. authors were required to comment if a rank lower than ‘strongly agree’ was provided. during the second voting round, ECCO national representatives also participated, although consensus was calculated from votes cast by members of this project alone. the participants met over a web-based video conference in november 2021 to discuss and vote on the statements and recommendations. consensus was defined as agreement by 80% or more participants. resulting consensus statements [with percentage agreement] are presented in this manuscript. we would like to stress the importance of interpreting each statement within the context of the supporting text provided, which is designed to add context and is of particular relevance given the paucity of data available for some of these critically important topics. Indeed, expert opinion has been included where appropriate when data were considered sparse, but the authors recognised that there was a clear need for clinical advice. the level of evidence supporting all statements is defined using the oxford methodology.2 throughout the text of this guideline, we cite original studies that use different epidemiological measures, such as hazard ratio [HR], odds ratio [OR], incidence ratio [IR], and relative risk [RR]. where we refer to these measures, we have quoted the original values. there are some important differences between these terms and we encourage readers to familiarise themselves as necessary.3 all figures were created with biorender®.4