- For patients with acute uncomplicated diverticulitis (AUD), observational management appears to be safe.
Why this matters
- Despite decades of clinical experience treating AUD with antibiotics, sufficient evidence does not exist to ratify the practice.
- The open-label, multicenter AVOD 1 and DIABOLO 2 randomized trials found that an observational approach was as safe as antibiotics.
- However, underpowered secondary outcomes suggested possible higher rates of complicated diverticulitis and sigmoid resections in the observational groups.
- The trials had different outcome definitions and follow-up times, complicating ordinary meta-analysis.
- Observational vs antibiotic groups:
- Length of stay: 2 vs 3 days (P=.037; nonsignificant in this study, which set significance at <.025>
- Ongoing diverticulitis: 7.2% vs 5.0% (P=.062).
- Recurrent diverticulitis: 8.6% vs 9.6% (P=.610).
- Complicated diverticulitis rates at 1 month and 1 year were similar.
- So were sigmoid resection rates.
- Individual patient data (IPD) meta-analysis of AVOD and DIABOLO (n=1109).
- Participants had left‐sided, CT‐proven AUD.
- Outcomes: duration of hospital stay; rates of ongoing diverticulitis, recurrent diverticulitis, complicated diverticulitis, and sigmoid resection at 12-month follow-up.
- Funding to AVOD and DIABOLO: Finnish, Dutch nonprofits.
- Authors had to redefine some outcomes to allow for comparison across studies.