Patient involvement remains limited in benign foregut surgery guidelines

Researchers searched databases and professional society websites for clinical practice guidelines (CPGs) on endoscopic or surgical management of benign foregut disease published from January 2010 to March 2026. Two reviewers assessed patient involvement across the 10-stage Armstrong framework and evaluated guideline quality using AGREE II. The review included 26 CPGs; all used evidence-grading methods.

Only 8 CPGs (31%) reported direct patient involvement, while 6 (23%) considered patient values indirectly through literature review and clinician assumptions. No guideline published before 2018 reported direct involvement. Among the 8 that did, patients were engaged in recommendation development in all cases, and in evidence interpretation and question or outcome formulation in 5 each. None reported involving patients in dissemination, implementation, updating, or evaluation of engagement. Later publication year was associated with direct involvement (OR 1.54 per year).

Patient-involved guidelines had higher unadjusted AGREE II scores for clarity, applicability, and editorial independence, but these differences were not statistically significant in sensitivity analyses. The findings describe guideline-development practices, not whether patient involvement improves patient outcomes. The authors call for more transparent, comprehensive patient partnership throughout guideline development.