Acute uncomplicated diverticulitis is manageable with observation: IPD meta-analysis

  • van Dijk ST & al.
  • Br J Surg
  • 19 Feb 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.
  • No subgroups did better with antibiotics.

Study design

  • 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.

Limitations

  • Authors had to redefine some outcomes to allow for comparison across studies.