EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice

Abstract

Background Acute diverticulitis (AD) presents a unique diagnostic and therapeutic challenge for general surgeons. This collaborative project between EAES and SAGES aimed to summarize recent evidence and draw statements of recommendation to guide our members on comprehensive AD management. Methods Systematic reviews of the literature were conducted across six AD topics by an international steering group including experts from both societies. Topics encompassed the epidemiology, diagnosis, management of non-complicated and complicated AD as well as emergency and elective operative AD management. Consensus statements and recommendations were generated, and the quality of the evidence and recommendation strength rated with the GRADE system. Modified Delphi methodology was used to reach consensus among experts prior to surveying the EAES and SAGES membership on the recommendations and likelihood to impact their practice. Results were presented at both EAES and SAGES annual meetings with live re-voting carried out for recommendations with < 70% agreement. Results A total of 51 consensus statements and 41 recommendations across all six topics were agreed upon by the experts and submitted for members’ online voting. Based on 1004 complete surveys and over 300 live votes at the SAGES and EAES Diverticulitis Consensus Conference (DCC), consensus was achieved for 97.6% (40/41) of recommendations with 92% (38/41) agreement on the likelihood that these recommendations would change practice if not already applied. Areas of persistent disagreement included the selective use of imaging to guide AD diagnosis, recommendations against antibiotics in non-complicated AD, and routine colonic evaluation after resolution of non-complicated diverticulitis. Conclusion This joint EAES and SAGES consensus conference updates clinicians on the current evidence and provides a set of recommendations that can guide clinical AD management practice. Electronic supplementary material The online version of this article (10.1007/s00464-019-06882-z) contains supplementary material, which is available to authorized users.

Reactive leukocytosis in older patients with acute colonic diverticulitis: A retrospective study utilizing logistic regression analysis

“…22,23 For example, ACD showed a remarkable predominance in female patients who were ≥70 years old, while it was predominant in male patients who were <50 years old. 24 Although no etiology was proposed for the predominance in female older patients, we think that delayed onset and progression of diverticulosis in females compared with males may explain the higher prevalence of females with diverticulitis, a complication of diverticulosis, in older age because the prevalence of diverticular disorders in all age groups is higher in male patients. Male patients may develop diverticular diseases younger than female patients due to a potentially earlier onset of diverticulosis.…”

“…Male patients may develop diverticular diseases younger than female patients due to a potentially earlier onset of diverticulosis. 22,24 Because of the lack of Japanese data on age-related differences in the sex ratio, we think that our study provides new data on the epidemiology of diverticulitis in Japan.…”

Protocol of an interdisciplinary consensus project aiming to develop an AGREE II extension for guidelines in surgery

“…Our research group has acted as methodological and content coordinators of landmark surgical guidelines and have served as members of surgical guideline development groups. [9][10][11][12][13][14] Even though members of our group, in their role as guideline developers, have made every effort to comply with the highest methodological standards, as indicated by adherence to Grading of Recommendations Assessment, Development and Evaluation (GRADE) and AGREE II methodologies, 15 16 we noticed that compliance with all aspects of several parameters of the AGREE II instrument was not possible. For example, the item 'The potential resource implications of applying the recommendations have been considered' may be difficult to be universally addressed.…”

Conservative management of acute perforated diverticulitis: A systematic review

“…It is determined according to computed tomography imaging (Hinchey I and II) or operative findings (Hinchey III and IV). Considerable efforts have been undertaken to investigate the optimal surgical strategy for patients with Hinchey III or IV diverticulitis who need urgent surgery . The Hartmann's operation has previously been regarded the gold standard; however, the surgical boundaries have been tested with recent randomized trials, suggesting that primary anastomosis with a diverting stoma results in a lower permanent stoma rate than in a Hartmann operation .…”