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Should Elective Resection Follow Nonoperative Management of First Episode of Acute Diverticulitis of the Colon with Abscess/Extraluminal Air? An RCT
Ryan Bendl*, Karen You*, Simona Giuratrabocchetta*, Ryan Sullivan*, Paula I Denoya*, Roberto Bergamaschi
State University of New York, Stony Brook, Stony Brook, NY

OBJECTIVE(S): An RCT was conducted to test the null hypothesis that there is no difference between observation and elective resection following nonoperative management of first episode of acute diverticulitis of the colon with extraluminal air/abscess for recurrence rates at follow-up.
METHODS: This was a single-center RCT registered at clinicaltrials.gov: NCT1986686. Eligible patients were randomized to observation or resection following nonoperative management, defined as NPO, IV antibiotics, drainage, and total parenteral nutrition followed by colonoscopy. Randomization was carried out according to the CONSORT guidelines. The primary endpoint was recurrent diverticulitis defined as an acute episode confirmed at CT, requiring hospitalization with IV antibiotics. Patients with immunosuppression, peritonitis, or history of prior diverticulitis of the colon were not included. A sample of 75 patients with an intended 2:1 ratio was required assuming a 5% alfa level, 80% power, and a 20% estimated loss to follow-up.
RESULTS: Of 137 screened, 126 eligible patients underwent the allocated intervention after nonoperative management. 8% of patients were lost to a follow-up of 16 (12-48) months. 77 observation patients were comparable to 39 resected patients for age, gender, BMI, CR-POSSUM, and comorbidities. Recurrence rates after observation and resection differed; 29.8% vs. 10%, p = 0.03; Kaplan-Meier log rank p=0.07. Diverticulitis recurred in 27 patients with no instance of peritonitis.
CONCLUSIONS: Observation following nonoperative management was associated with increased recurrence rates at follow-up as compared to elective resection.


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