S T van Dijk1, L Daniels1,1, Ç Ünlü1, N de Korte1, S van Dieren1, H B Stockmann1, B C Vrouenraets1, E C Consten1, J A van der Hoeven1, Q A Eijsbouts1, I F Faneyte1, W A Bemelman1, M G Dijkgraaf1, M A Boermeester1. 1. Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands.
Abstract
BACKGROUND: Traditionally uncomplicated acute diverticulitis was routinely treated with antibiotics, although evidence for this strategy was lacking. Recently, two randomized clinical trials (AVOD trial and DIABOLO trial) published short-term results of omitting antibiotics compared to routine antibiotic treatment. Both showed no significant differences regarding recovery from the initial episode, as well as rates of complicated or recurrent diverticulitis and sigmoid resection. However, both studies showed a trend of higher rates of sigmoid resection in the observational groups. Here, the long-term effects of omitting antibiotics in first episode uncomplicated acute diverticulitis were assessed. METHODS: A total of 528 patients with CT-proven, primary, left-sided, uncomplicated acute diverticulitis were randomized to either an observational or an antibiotic treatment strategy (DIABOLO trial). Outcome measures were complicated diverticulitis, recurrent diverticulitis and sigmoid resection at 24 months' follow up. Differences between the groups were explored and risk factors were identified using multivariable logistic regression. RESULTS: Complete case analyses showed no difference in rates of recurrent diverticulitis (15.4% in the observational group versus 14.9% in the antibiotic group; p = 0.885), complicated diverticulitis (4.8% versus 3.3%; p = 0.403) and sigmoid resection (9.0% versus. 5.0%; p = 0.085). Young patients (<50 years) and patients with a pain score at presentation of 8 or higher on a visual analogue pain scale were at risk for complicated or recurrent diverticulitis. In this multivariable analysis, treatment type (with or without antibiotics) was not an independent predictor for complicated or recurrent diverticulitis. CONCLUSION:Omitting antibiotics in the treatment of uncomplicated acute diverticulitis did not result in more complicated diverticulitis, recurrent diverticulitis or sigmoid resections at long-term follow up. As the DIABOLO trial was not powered for these secondary outcome measures, some uncertainty remains whether (small) non-significant differences could be true associations.
RCT Entities:
BACKGROUND: Traditionally uncomplicated acute diverticulitis was routinely treated with antibiotics, although evidence for this strategy was lacking. Recently, two randomized clinical trials (AVOD trial and DIABOLO trial) published short-term results of omitting antibiotics compared to routine antibiotic treatment. Both showed no significant differences regarding recovery from the initial episode, as well as rates of complicated or recurrent diverticulitis and sigmoid resection. However, both studies showed a trend of higher rates of sigmoid resection in the observational groups. Here, the long-term effects of omitting antibiotics in first episode uncomplicated acute diverticulitis were assessed. METHODS: A total of 528 patients with CT-proven, primary, left-sided, uncomplicated acute diverticulitis were randomized to either an observational or an antibiotic treatment strategy (DIABOLO trial). Outcome measures were complicated diverticulitis, recurrent diverticulitis and sigmoid resection at 24 months' follow up. Differences between the groups were explored and risk factors were identified using multivariable logistic regression. RESULTS: Complete case analyses showed no difference in rates of recurrent diverticulitis (15.4% in the observational group versus 14.9% in the antibiotic group; p = 0.885), complicated diverticulitis (4.8% versus 3.3%; p = 0.403) and sigmoid resection (9.0% versus. 5.0%; p = 0.085). Young patients (<50 years) and patients with a pain score at presentation of 8 or higher on a visual analogue pain scale were at risk for complicated or recurrent diverticulitis. In this multivariable analysis, treatment type (with or without antibiotics) was not an independent predictor for complicated or recurrent diverticulitis. CONCLUSION: Omitting antibiotics in the treatment of uncomplicated acute diverticulitis did not result in more complicated diverticulitis, recurrent diverticulitis or sigmoid resections at long-term follow up. As the DIABOLO trial was not powered for these secondary outcome measures, some uncertainty remains whether (small) non-significant differences could be true associations.
Authors: Jeong Yeon Kim; Sung Gil Park; Hee Joon Kang; Young Ah Lim; Kyung Ho Pak; Tae Yoo; Won Tae Cho; Dong Woo Shin; Jong Wan Kim Journal: Int J Colorectal Dis Date: 2019-07-02 Impact factor: 2.571
Authors: Massimo Sartelli; Dieter G Weber; Yoram Kluger; Luca Ansaloni; Federico Coccolini; Fikri Abu-Zidan; Goran Augustin; Offir Ben-Ishay; Walter L Biffl; Konstantinos Bouliaris; Rodolfo Catena; Marco Ceresoli; Osvaldo Chiara; Massimo Chiarugi; Raul Coimbra; Francesco Cortese; Yunfeng Cui; Dimitris Damaskos; Gian Luigi De' Angelis; Samir Delibegovic; Zaza Demetrashvili; Belinda De Simone; Francesco Di Marzo; Salomone Di Saverio; Therese M Duane; Mario Paulo Faro; Gustavo P Fraga; George Gkiokas; Carlos Augusto Gomes; Timothy C Hardcastle; Andreas Hecker; Aleksandar Karamarkovic; Jeffry Kashuk; Vladimir Khokha; Andrew W Kirkpatrick; Kenneth Y Y Kok; Kenji Inaba; Arda Isik; Francesco M Labricciosa; Rifat Latifi; Ari Leppäniemi; Andrey Litvin; John E Mazuski; Ronald V Maier; Sanjay Marwah; Michael McFarlane; Ernest E Moore; Frederick A Moore; Ionut Negoi; Leonardo Pagani; Kemal Rasa; Ines Rubio-Perez; Boris Sakakushev; Norio Sato; Gabriele Sganga; Walter Siquini; Antonio Tarasconi; Matti Tolonen; Jan Ulrych; Sannop K Zachariah; Fausto Catena Journal: World J Emerg Surg Date: 2020-05-07 Impact factor: 5.469