Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: time to change traditional practice

Abstract

Background To evaluate comparative outcomes of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey grade 1a) acute diverticulitis. Methods A systematic online search was conducted using electronic databases. Comparative studies of OP versus IP treatment and ABX versus NABX approach in the treatment of Hinchey grade 1a acute diverticulitis were included. Primary outcome was recurrence of diverticulitis. Emergency and elective surgical resections, development of complicated diverticulitis, mortality rate, and length of hospital stay were the other evaluated secondary outcome parameters. Results The literature search identified twelve studies (n = 3,875) comparing NABX (n = 2,008) versus ABX (n = 1,867). The NABX group showed a lower disease recurrence rate and shorter length of hospital stay compared with the ABX group (P = 0.01) and (P = 0.004). No significant difference was observed in emergency resections (P = 0.33), elective resections (P = 0.73), development of complicated diverticulitis (P = 0.65), hospital re-admissions (P = 0.65) and 30-day mortality rate (P = 0.91). Twelve studies (n = 2,286) compared OP (n = 1,021) versus IP (n = 1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P = 0.10), emergency surgical resection (P = 0.40), elective resection (P = 0.30), disease recurrence (P = 0.22), and mortality rate (P = 0.61). Conclusion Observation-only treatment is feasible and safe in selected clinically stable patients with uncomplicated acute diverticulitis (Hinchey 1a classification). It may provide better outcomes including decreased length of hospital stay. Moreover, the OP approach in treating patients with Hinchey 1a acute diverticulitis is comparable to IP management. Future high-quality randomised controlled studies are needed to understand the outcomes of the NABX approach used in an OP setting in managing patients with uncomplicated acute diverticulitis.

Revisiting traditional practices in the management of acute uncomplicated diverticulitis: a call for change

“…Moreover, the outpatient (OP) approach in treating patients with Hinchey 1a acute diverticulitis is comparable to inpatient (IP) management. Future high-quality randomised controlled studies are needed to understand the outcomes of the non-antibiotic (NABX) approach used in an OP setting in managing patients with uncomplicated acute diverticulitis [ 1 ].…”

Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: time to change traditional practice

“…We read with interest the commentary on our recently published article [ 1 ] in the International Journal of Colorectal Disease by Aamir et al titled ‘Revisiting traditional practices in the management of acute uncomplicated diverticulitis: a call for change’ [ 2 ]. We appreciate their timely contribution and the important points raised.…”