ABSTRACT Objective Fecal microbiota transplantation (FMT) is an emerging multi‐disease therapy, yet the quality and consistency of its available clinical practice guidelines (CPGs) remain unknown. This study aimed to systematically evaluate the quality, content coverage and recommendation consistency of FMT‐related guidelines and develop an optimization framework for evidence‐informed future guideline revision and standardized FMT clinical practice. Methods We searched PubMed, Embase, Web of Science Core Collection, The Cochrane Library, CNKI, WanFang Data, and official websites of guideline development organizations and professional societies from inception to March 11, 2026. Two reviewers independently screened and selected CPGs with actionable recommendations and conducted quality evaluation via the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Intraclass correlation coefficient (ICC) with 95% confidence intervals (CIs) was computed for each AGREE II domain and interpreted according to Fleiss’ criteria. Inter‐guideline agreement was reported as the percentage of CPGs endorsing each recommendation. Results Eighteen CPGs (3 general, 15 FMT‐specific) with 191 recommendations were included. Applicability obtained the lowest AGREE II score (37.8%), followed by rigor of development (47.4%) and stakeholder involvement (49.7%). General guidelines scored higher than FMT‐specific guidelines in applicability (62.5% vs. 32.9%) and stakeholder involvement (59.3% vs. 47.8%), but lower in rigor of development (38.9% vs. 49.1%). The coverage of recommendations showed marked inter‑guideline heterogeneity. Recurrent Clostridioides difficile infection (rCDI) was the most consistently recommended indication with the highest level of evidence (10/16). Over 75% of guidelines ignored transplant‐center management, and non‐CDI indications and key operational steps lacked sufficient high‐certainty evidence. ICCs (0.86–0.97) showed excellent evaluator consistency. Conclusions Current FMT guidelines exhibit significant methodological deficiencies, heterogeneous recommendation coverage, and limited consensus beyond rCDI. FMT‐specific guidelines show better developmental rigor but poorer applicability than general guidelines. Future FMT guideline development should establish core topic sets, adopt multidisciplinary collaborative mechanisms, and develop implementation toolkits with regular update protocols.
ABSTRACT Background Baduanjin (BDJ) is a traditional Chinese mind–body exercise increasingly evaluated in rehabilitation and chronic disease care. The growth of systematic reviews has made the literature difficult to interpret because review volume, methodological quality, certainty of evidence, and overlap of primary trials are rarely considered together. This umbrella review aimed to map the clinical condition spectrum of BDJ research and to appraise the credibility and redundancy of the existing review evidence. Methods Eight English and Chinese databases were searched from inception to April 2026 for systematic reviews and meta‐analyses in which BDJ was a standalone or separable intervention. Eligible reviews were mapped by clinical condition. Representative core reviews were selected using prespecified hierarchical criteria. Methodological quality, certainty of evidence, and primary‐trial overlap were assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), grading of recommendations assessment, development and evaluation (GRADE), and corrected covered area (CCA), respectively. Results A total of 261 reviews were included. Thirty‐one core reviews underwent AMSTAR 2 appraisal, 21 condition–outcome pairs underwent GRADE assessment, and 10 review clusters underwent CCA analysis. Review activity was concentrated in cardiovascular/cardiac rehabilitation, musculoskeletal pain, cognitive/neurological rehabilitation, endocrine/metabolic disorders, psychological/sleep/emotional conditions, oncology/postoperative rehabilitation, and respiratory disease. AMSTAR 2 ratings were moderate in one review, low in 18, and critically low in 12. Nineteen condition–outcome pairs were rated low certainty and 2 very low certainty. Several clusters showed high or very high primary‐trial overlap. Conclusions BDJ has been reviewed widely, but the evidence is methodologically uneven, frequently overlapping, and of low or very low certainty. Current findings should be interpreted as uncertain evidence signals rather than practice recommendations.
ABSTRACT Aims Stage at diagnosis is a key factor influencing survival in patients with esophageal cancer. This study aims to assess the distribution of esophageal cancer stage at diagnosis using registry data from multiple countries/regions. Methods PubMed, Embase, CNKI, and WanFang Data were systematically searched, supplemented by grey literature from cancer registry reports. Population‐ or hospital‐based registry studies reporting stage distribution at diagnosis according to tumor‐node‐metastasis or Surveillance, Epidemiology, and End Results systems were included. Sex‐specific stage distributions, associations of the Human Development Index (HDI) and Socio‐Demographic Index (SDI) with distant metastasis, and temporal trends in stage distribution were assessed. Results Stage data from 23 countries/regions were included. Among the 22 countries/regions in the primary analysis, the proportion of cases with distant metastasis varied substantially, with a median of 26.6% (interquartile range: 18.7%–35.9%), highest in Czechia (43.7%). Among the 11 countries with sex‐stratified data, males had a higher proportion of distant metastasis than females in all but Norway. Weighted ecological analyses showed no statistically significant associations of HDI or SDI with the proportion of cases with distant metastasis ( p > 0.05). Temporal trends showed that the proportion of distant metastasis remained generally stable in most countries/regions, with the Republic of Korea below 20%. Conclusions A substantial proportion of patients with esophageal cancer presented with distant metastasis at diagnosis, with marked regional and sex differences in stage distribution. Further research is needed to identify factors associated with stage variation and improve cancer registration and staging data quality.
