# Reviews, expert opinions, consensus statements, position papers, protocols, and evidence-based guidelines: what are their roles in clinical practice?

## TL;DR

This paper explains the different types of clinical guidance documents and their roles in digestive surgery, emphasizing the need for clarity and appropriate use to improve patient care.

## Contribution

The paper clarifies the distinctions between various clinical guidance formats and advocates for methodological transparency and new tools like AI to enhance clinical decision-making.

## Key findings

- Clinical guidance documents differ in purpose and should not be used interchangeably.
- Structured consensus is valuable when evidence is limited or conflicting.
- Future guidance may use AI and living systematic reviews to improve updates and transparency.

## Abstract

The growth of primary research in digestive surgery has led to an increasing need for structured interpretation and application to clinical practice. Guidance documents have become essential tools for decision-making. However, the terminology surrounding clinical guidance documents is frequently inconsistent, and different formats are often used interchangeably. Although review articles synthesize available evidence, they do not constitute clinical guidance unless their findings are interpreted through a framework explicitly oriented toward patient care, applicability, and decision-making. This review article clarifies the conceptual distinctions between expert opinion, consensus statements, position papers, protocols, and evidence-based guidelines. No single guidance format is universally superior, and each has its appropriate context. In digestive surgery, where randomized trials are often difficult to perform and evidence gaps remain frequent, structured interpretation is indispensable. As technology advances and real-world data become increasingly available, new methodological tools — including artificial intelligence and living systematic reviews — may enhance reproducibility and accelerate updates. Ultimately, clearer distinctions among guide orientations and greater methodological transparency may improve clinical judgment, stimulate research, and strengthen patient care in gastrointestinal surgery.

Clinical practice guidance documents differ in purpose, methodology, and level of evidence. They should not be used interchangeably.

Evidence-based guidelines rely on systematic review but require time, expertise, and substantial resources.

Structured consensus is especially valuable when evidence is limited or conflicting.

Protocols and position papers can evolve toward stronger evidence-based frameworks when prospectively validated, as seen with ERAS (Enhanced Recovery After Surgery) and ACERTO (ACEleração da Recuperação TOtal Pós-operatória).

Clinical practice guidance documents are not all the same. In digestive surgery, evidence-based guidelines, consensus statements, position papers, and protocols each serve different purposes, and the distinctions between them should be clear. Recognizing the strengths and limitations of each format is essential to improving decision-making, guiding research, and ultimately benefiting our patients.

Digestive surgery evolves rapidly, and traditional publication models may not keep pace with emerging technologies and clinical demands. Future guidance documents are expected to incorporate artificial intelligence for evidence screening, living systematic reviews for continuous updates, and transparent digital repositories for open access to consensus voting and dissent. National registries and real-world data will complement trials where randomized evidence is scarce.