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Systematic review and comparison of national and international guidelines on diverticular disease

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Abstract

Purpose

Diverticular disease is common and of increasing medical and economical importance. Various practice guidelines on diagnostic and treatment on this disease exist. We compared current guidelines on the disease in order to identify concordant and discordant recommendations.

Method

Eleven national and international guidelines on diverticular disease published over the last 10 years have been identified by a systematic literature review on PubMed and compared in detail for 20 main and 51 subtopics.

Results

The available evidence for the most aspects was rated as moderate or low. There was concordance for the following items: Diagnosis of diverticulitis should be confirmed by imaging methods (10 of 10 guidelines). Mild forms may be treated out-patient (10/10). Abscesses are treated non-surgically (9/9). Elective surgery should be indicated by individual patient-related factors, only, and be performed laparoscopically (10/10, 9/9 respectively). Main differences were found in the questions of appropriate classification, imaging diagnostic (computed-tomography versus ultra-sound), need for antibiotics in out-patient treatment and mode of surgery for diverticular perforation. Despite growing evidence that antibiotics are not needed for treating mild diverticulitis, only 3/10 guidelines have corresponding recommendations. Hartmann’s procedure has been abandoned several years ago and is now recommended for feculent peritonitis by the three most recent guidelines. In contrast, laparoscopic lavage without resection is not recommended anymore.

Conclusion

There are dissents in the recommendations for central aspects regarding the diagnostic and treatment of diverticular disease in recently published guidelines.

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Authors and Affiliations

  1. Department of General, Visceral and Thoracic Surgery, Leverkusen General Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany

    T. Galetin, A. Galetin, K.-H. Vestweber & A. D. Rink

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Contributions

Thomas Galetin and Amelie Galetin did the literature research and identified the respective guidelines. Thomas Galetin reviewed and analysed the guidelines in detail and wrote the manuscript. Andreas D. Rink and Karl-Heinz Vestweber provided substantial contributions to the conception and design and interpretation of data; Andreas D. Rink revised the manuscript critically for important intellectual content. All authors contributed to an internal final revision process for submission of the manuscript.

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Correspondence to T. Galetin or A. D. Rink.

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Galetin, T., Galetin, A., Vestweber, KH. et al. Systematic review and comparison of national and international guidelines on diverticular disease. Int J Colorectal Dis 33, 261–272 (2018). https://doi.org/10.1007/s00384-017-2960-z

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