Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

Binda, Gian Andrea; Cuomo, Rosario; Laghi, Andréa; Nascimbeni, Riccardo; Serventi, A.; Gervaz, Pascal; Annibale, Bruno

doi:10.1007/s10151-015-1370-x

Cited by 94 publications

(116 citation statements)

References 167 publications

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“…Several national and international guidelines on acute diverticulitis have been published in recent years. The recommendations in these guidelines are conflicting, and the evidence on which they based differs.…”

Section: Discussionmentioning

confidence: 99%

“…The recommendations in these guidelines are conflicting, and the evidence on which they based differs. Most of the guidelines (6 of 8) recommend routine colonoscopy after an episode of acute diverticulitis to rule out malignancy, although the American Gastroenterological Association (AGA) suggests that previous colonoscopies, co‐morbidities, persistent symptoms and patients' preferences may influence the decision. The scientific grounds for the recommendations in these six guidelines are noteworthy.…”

Section: Discussionmentioning

confidence: 99%

“…Even though the risk of colorectal carcinoma in patients with acute diverticulitis has been the topic of debate in multiple studies, there remains a lack of clarity. The majority of guidelines still recommends routine colonoscopy after an episode of acute diverticulitis. The objective of this review was to assess the role of colonoscopy in patients with CT‐proven acute diverticulitis in detecting a colorectal carcinoma that is presenting as acute diverticulitis or is masked by acute diverticulitis.…”

Section: Introductionmentioning

confidence: 99%

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Meta-analysis of the role of colonoscopy after an episode of left-sided acute diverticulitis

Rottier

Dijk

Geloven

et al. 2019

British Journal of Surgery

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Background Routine colonoscopy was traditionally recommended after acute diverticulitis to exclude coexistent malignancy. Improved CT imaging may make routine colonoscopy less required over time but most guidelines still recommend it. The aim of this review was to assess the role of colonoscopy in patients with CT‐proven acute diverticulitis. Methods PubMed and Embase were searched for studies reporting the prevalence of advanced colorectal neoplasia (ACN) or colorectal carcinoma in patients who underwent colonoscopy within 1 year after CT‐proven left‐sided acute diverticulitis. The prevalence was pooled using a random‐effects model and, if possible, compared with that among asymptomatic controls. Results Seventeen studies with 3296 patients were included. The pooled prevalence of ACN was 6·9 (95 per cent c.i. 5·0 to 9·4) per cent and that of colorectal carcinoma was 2·1 (1·5 to 3·1) per cent. Only two studies reported a comparison with asymptomatic controls, showing comparable risks (risk ratio 1·80, 95 per cent c.i. 0·66 to 4·96). In subgroup analysis of patients with uncomplicated acute diverticulitis, the prevalence of colorectal carcinoma was only 0·5 (0·2 to 1·2) per cent. Conclusion Routine colonoscopy may be omitted in patients with uncomplicated diverticulitis if CT imaging is otherwise clear. Patients with complicated disease or ongoing symptoms should undergo colonoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Meta-analysis of the role of colonoscopy after an episode of left-sided acute diverticulitis

Rottier

Dijk

Geloven

et al. 2019

British Journal of Surgery

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“…Surgical procedures commonly selected are Hartmann's opera- tion, colectomy, and drainage therapy [166]. In addition, the superiority of laparoscopic surgery over laparotomy in terms of severity of complications and length of hospital stay has been shown in recent years [152,156,167].…”

Section: Cq35: Is Emergency Surgery Necessary For Colonic Diverticulimentioning

confidence: 99%

“…Accordingly, recurrent colonic diverticulitis without abscess or perforation alone is not an indication for surgery (and is not an indication for preventive colectomy). Elective surgery is considered based on the state of immunodeficiency (e.g., post-transplantation), severity of recurrent diverticulitis, presence of comorbidities, and age [156][157][158].…”

Section: Cq33: Is Antibiotic Therapy Recommended For Colonic Diverticmentioning

confidence: 99%

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

et al. 2019

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Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. As a result, patients with colonic diverticular disease are often bothered by required frequent examinations, re-hospitalization, and a consequent decrease in quality of life. However, the management of diverticular disease differs between Japan and Western countries. For example, computed tomography (CT) is readily accessible at Japanese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular disease. Endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding. Administration of antibiotics and complete bowel rest may be considered as first-line therapy for colonic diverticulitis. In addition, diverticula occur mainly in the sigmoid colon in Western countries, whereas the right side or bilateral of the colon is more commonly involved in Japan. As such, diverticular disease in the right-side colon is more prevalent in Japan than in Western countries. Against this background, concern is growing about the management of colonic diverticular disease in Japan and there is currently no practice guideline available. To address this situation, the Japanese Gastroenterological Association decided to create a clinical guideline for colonic diverticular bleeding and colonic diverticulitis in collaboration with the Japanese Society of Gastroenterology, Japan Gastroenterological Endoscopy Society, and Japanese Society of Interventional Radiology. The steps taken to establish this guideline involved incorporating the concept of the GRADE system for rating clinical guidelines, developing clinical questions (CQs), accumulating evidence through a literature search and review, and developing the Statement and Explanation sections. This guideline includes 2CQs for colonic diverticulosis, 24 CQs for colonic diverticular bleeding, and 17 CQs for diverticulitis.

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Antibiotics for uncomplicated diverticulitis

Dichman

Rosenstock

Shabanzadeh

2022

Cochrane Database of Systematic Reviews

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Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

Cited by 94 publications

References 167 publications

Meta-analysis of the role of colonoscopy after an episode of left-sided acute diverticulitis

Meta-analysis of the role of colonoscopy after an episode of left-sided acute diverticulitis

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

Antibiotics for uncomplicated diverticulitis

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