Saudi gastroenterology association guidelines for the diagnosis and management of hepatocellular carcinoma: Summary of recommendations

Abstract

Recognizing the high prevalence of hepatocellular carcinoma (HCC) in Saudi Arabia and the diffi culties often faced in accurate diagnoses, evidence-based management, and appropriate referral of HCC patients, a committee was formed at King Khalid University Hospital (KKUH) in Riyadh (first three editors, AAA, HAK, TF) who wrote the fi rst draft of these guidelines. Th ese editors first performed a widely based literature search on all aspects of the epidemiology, natural history, risk factors, diagnosis, and management of HCC. Th e literature was examined critically and the available evidence was then classifi ed according to its strength. After approval and implementation of the initial guidelines at KKUH, it was decided to use these guidelines as the backbone for a national project for Saudi Arabia. Th ree other editors (FMS, MK, AJ) from three of the major hospitals in Saudi Arabia updated the document. After that, representative expert contributors were invited to review the document. Th ese contributors (listed at the end of this article), who are experts in diff erent specialties related to HCC management from diff erent institutions in Saudi Arabia, then further refi ned and updated the sections related to their expertise. Multiple meetings were then called to approve the fi nal document. An international expert in the area of HCC (KB) then reviewed the document and off ered useful suggestions and improvements. After that, the Saudi Gastroenterology Association formed a committee that reviewed these guidelines and approved them as the “Saudi Guidelines for the Diagnosis and Management of Hepatocellular Carcinoma”. Th e recommendations are based on the best available evidence but were tailored to the patients treated in Saudi Arabia. We have benefi ted from the two published European guidelines. Th e fi rst is the conclusion of the Barcelona-2000 European Association for the Study of the Liver Conference,1 and the second is the guide- lines published by the British Society of Gastroenterology.2 In addi- tion, we have benefi ted from the special dedicated supplement issue of Gastroenterology (November 2004) containing extensive reviews of the topic and from the American Association for the Study of the Liver (AASLD) guidelines that were recently published.3 We hope that these guidelines will improve care for patients with HCC and facilitate the performance of excellent research on this important medical problem.