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

Nader K Francis; Patricia Sylla; Maria Abou-Khalil; Simone Arolfo; David Berler; Nathan J Curtis; Scott C Dolejs; Richard Garfinkle; Marguerite Gorter-Stam; Daniel A Hashimoto; Taryn E Hassinger; Charlotte J L Molenaar; Philip H Pucher; Valérie Schuermans; Alberto Arezzo; Ferdinando Agresta; Stavros A Antoniou; Tan Arulampalam; Marylise Boutros; Nicole Bouvy; Kenneth Campbell; Todd Francone; Stephen P Haggerty; Traci L Hedrick; Dimitrios Stefanidis; Mike S Truitt; Jillian Kelly; Hans Ket; Brian J Dunkin; Andrea Pietrabissa

doi:10.1007/s00464-019-06882-z

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

Surg Endosc. 2019 Sep;33(9):2726-2741. doi: 10.1007/s00464-019-06882-z. Epub 2019 Jun 27.

Authors

Nader K Francis¹, Patricia Sylla², Maria Abou-Khalil³, Simone Arolfo⁴, David Berler², Nathan J Curtis^{5

6

7}, Scott C Dolejs⁸, Richard Garfinkle³, Marguerite Gorter-Stam⁹, Daniel A Hashimoto¹⁰, Taryn E Hassinger¹¹, Charlotte J L Molenaar¹², Philip H Pucher¹³, Valérie Schuermans¹⁴, Alberto Arezzo⁴, Ferdinando Agresta¹⁵, Stavros A Antoniou¹⁶, Tan Arulampalam¹⁷, Marylise Boutros³, Nicole Bouvy¹⁴, Kenneth Campbell^{18

19}, Todd Francone²⁰, Stephen P Haggerty^{21

22}, Traci L Hedrick¹¹, Dimitrios Stefanidis⁸, Mike S Truitt²³, Jillian Kelly²⁴, Hans Ket⁹, Brian J Dunkin²⁵, Andrea Pietrabissa²⁶

Affiliations

¹ Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK. nader.francis@ydh.nhs.uk.
² Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA.
³ Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, Montreal, Canada.
⁴ Department of Surgical Sciences, University of Torino, Toriano, Italy.
⁵ Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK. nathancurtis@doctors.org.uk.
⁶ Department of Surgery and Cancer, Imperial College London, London, UK. nathancurtis@doctors.org.uk.
⁷ Department of General Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK. nathancurtis@doctors.org.uk.
⁸ Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
⁹ Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
¹⁰ Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
¹¹ Department of Surgery, The University of Virginia Health System, Charlottesville, VA, USA.
¹² Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands.
¹³ Department of General Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
¹⁴ Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
¹⁵ Department of General Surgery, ULSS5 del Veneto, Adria, Italy.
¹⁶ Department of Surgery, European University of Cyprus, Nicosia, Cyprus.
¹⁷ Department of General Surgery, Colchester General Hospital, Colchester, UK.
¹⁸ Department of Surgery, Ninewells Hospital, Dundee, UK.
¹⁹ School of Medicine, University of Dundee, Dundee, UK.
²⁰ Division of Colon & Rectal Surgery, Newton-Wellesley Hospital, Newton, MA, USA.
²¹ Division of General Surgery, NorthShore University Health System, Evanston, IL, USA.
²² Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
²³ Methodist Dallas Medical Center, Colchester, TX, USA.
²⁴ SAGES, Los Angeles, CA, USA.
²⁵ Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
²⁶ Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

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.

Keywords: Acute; Consensus; Diverticulitis; Elective surgery; Emergency surgery; Guidelines; Lavage.

Publication types

Consensus Development Conference
Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Diverticulitis* / diagnosis
Diverticulitis* / therapy
Endoscopy, Gastrointestinal / methods*
Evidence-Based Practice
Humans
Patient Care Management* / methods
Patient Care Management* / standards
Patient Selection