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Table 2 Grading of recommendations (from Guyatt et al.)

From: 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation

Grade of recommendation Description Benefits vs. risks Quality of supporting evidence Implications
1A Strong recommendation, high-quality evidence Benefits clearly outweigh risks and burdens, or vice versa RCTs without important limitations or overwhelming evidence from observational studies Strong recommendation, applies to most patients in most circumstances without reservation
1B Strong recommendation, moderate-quality evidence Benefits clearly outweigh risk and burdens, or vice versa RCTs with important limitations (inconsistent results, methodological flaws, indirect or imprecise) or exceptionally strong evidence from observational studies Strong recommendation, applies to most patients in most circumstances without reservation
1C Strong recommendation, low-quality or very low-quality evidence Benefits clearly outweigh risk and burdens, or vice versa Observational studies or case series Strong recommendation based on limited evidence; recommendations may change when higher quality or more extensive evidence becomes available
2A Weak recommendation, high-quality evidence Benefits closely balanced with risks and burdens RCTs without important limitations or overwhelming evidence from observational studies Weak recommendation; best action may differ depending on circumstances, expertise of clinician, the patient in question, or other social issues
2B Weak recommendation, moderate-quality evidence Benefits closely balanced with risks and burdens RCTs with important limitations (inconsistent results, methodological flaws, indirect or imprecise) or exceptionally strong evidence from observational studies Weak recommendation; best action may differ depending on circumstances, expertise of clinician, the patient in question, or other social issues
2C Weak recommendation, low-quality or very low quality evidence Uncertainty in the estimates of benefits, risks, and burdens; benefits, risks, and burdens may be closely balanced Observational studies or case series Very weak recommendation; other alternatives may be equally reasonable