Outcomes of initially nonoperative management of diverticulitis with abscess formation in immunosuppressed patients. DIPLICAB study COLLABORATIVE group.
| Title: | Outcomes of initially nonoperative management of diverticulitis with abscess formation in immunosuppressed patients. DIPLICAB study COLLABORATIVE group. |
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| Authors: | Ocaña J; Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.; García-Pérez JC; Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Fernández-Martínez D; Division of Coloproctology, Hospital Universitario Central de Asturias, Oviedo, Spain.; Aguirre I; Colorectal Surgery Unit, Hospital Universitario de Donostia, San Sebastián, Spain.; Pascual I; Colorectal Division, Hospital Universitario La Paz, Madrid, Spain.; Lora P; Colorectal Division, Hospital Univseristario Cabueñes, Gijón, Spain.; Espin-Basany E; Department of Colorectal Surgery, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.; Labalde-Martínez M; Division of Coloproctology, Hospital Universitario 12 de Octubre, Madrid, Spain.; León C; Division of Coloproctology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.; Pastor-Peinado P; Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.; López-Domínguez C; Division of Coloproctology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.; Muñoz-Plaza N; Division of Coloproctology, Hospital Universitario Burgos, Burgos, Spain.; Valle A; Division of Coloproctology, Hospital Universitario de Getafe, Getafe, Spain.; Dujovne P; Division of Coloproctology, Hospital Universitario Gregorio Marañón, Madrid, Spain.; Alías D; Unit of Coloproctology, Hospital Universitario Rey Juan Carlos, Móstoles, Spain.; Pérez-Santiago L; Division of Coloproctology, Hospital Clínico Universitario de Valencia, Valencia, Spain.; Correa A; Unit of Coloproctology, Hospital Universitario La Princesa, Madrid, Spain.; Carmona M; Division of Coloproctology, Hospital Universitario de Badajoz, Badajoz, Spain.; Fernández-Cebrián JM; Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Die J; Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain. |
| Corporate Authors: | collaborators from The DIPLICAB Study Collaborative Group |
| Source: | Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2024 Jan; Vol. 26 (1), pp. 120-129. Date of Electronic Publication: 2023 Nov 27. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Blackwell Science Ltd Country of Publication: England NLM ID: 100883611 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1463-1318 (Electronic) Linking ISSN: 14628910 NLM ISO Abbreviation: Colorectal Dis Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Oxford, UK : Blackwell Science Ltd. |
| MeSH Terms: | Diverticulitis, Colonic*/therapy ; Diverticulitis, Colonic*/complications ; Diverticulitis*/complications; Abscess/etiology ; Abscess/therapy ; Neoplasm Recurrence, Local/complications ; Humans ; Retrospective Studies |
| Abstract: | Aim: Management of diverticulitis with abscess formation in immunosuppressed patients (IMS) remains unclear. The main objective of the study was to assess short- and long-term outcomes between IMS and immunocompetent patients (IC). The secondary aim was to identify risk factors for emergency surgery.; Methods: A nationwide retrospective cohort study was performed at 29 Spanish referral centres between 2015-2019 including consecutive patients with first episode of diverticulitis classified as modified Hinchey Ib or II. IMS included immunosuppressive therapy, biologic therapy, malignant neoplasm with active chemotherapy and chronic steroid therapy. A multivariate analysis was performed to identify independent risk factors to emergency surgery in IMS.; Results: A total of 1395 patients were included; 118 IMS and 1277 IC. There were no significant differences in emergency surgery between IMS and IC (19.5% and 13.5%, p = 0.075) but IMS was associated with higher mortality (15.1% vs. 0.6%, p |
| References: | Etzioni DA, Mack TM, Beart RW, Kaiser AM. Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment. Ann Surg. 2009;249(2):210-217.; Bharucha AE, Parthasarathy G, Ditah I, Fletcher JG, Ewelukwa O, Pendlimari R, et al. Temporal trends in the incidence and natural history of diverticulitis: a population-based study. Am J Gastroenterol. 2015;110(11):1589-1596.; Heise CP. Epidemiology and pathogenesis of diverticular disease. J Gastrointest Surg. 2008;12(8):1309-1311.; Parks TG. Post-mortem studies on the colon with special reference to diverticular disease. J R Soc Med. 1968;61(9):932-934.; Bolkenstein HE, van de Wall BJM, Consten ECJ, Broeders IAMJ, Draaisma WA. Risk factors for complicated diverticulitis: systematic review and meta-analysis. Int J Colorectal Dis. 2017;32(10):1375-1383.; Strate LL, Morris AM. Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology. 2019;156(5):1282-1298.; Schultz JK, Azhar N, Binda GA, Barbara G, Biondo S, Boermeester MA, et al. European Society of Coloproctology: guidelines for the management of diverticular disease of the colon. Colorectal Dis. 2020;22(S2):5-28.; Coccolini F, Improta M, Sartelli M, Rasa K, Sawyer R, Coimbra R, et al. Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines. World J Emerg Surg. 2021;16(1):1-21.; Wood EH, Sigman MM, Hayden DM. Special situations in the management of diverticular disease. Clin Colon Rectal Surg. 2021;34(2):121-126.; Reshef A, Stocchi L, Kiran RP, Flechner S, Budev M, Quintini C, et al. Case-matched comparison of perioperative outcomes after surgical treatment of sigmoid diverticulitis in solid organ transplant recipients versus immunocompetent patients. Colorectal Dis. 2012;14(12):1546-1552.; Lederman ED, Conti DJ, Lempert N, Singh TP, Lee EC. Complicated diverticulitis following renal transplantation. Dis Colon Rectum. 1998;41(5):613-618.; Detry O, Defraigne JO, Meurisse M, Bertrand O, Demoulin JC, Honor P, et al. Acute diverticulitis in heart transplant recipients. Transpl Int. 1996;9(4):376-379.; Hwang SS, Cannom RR, Abbas MA, Etzioni D. Diverticulitis in transplant patients and patients on chronic corticosteroid therapy: a systematic review. Dis Colon Rectum. 2010;53(12):1699-1707.; Pourfarziani V, Mousavi-Nayeeni S-M, Ghaheri H, Assari S, Saadat SH, Panahi F, et al. The outcome of diverticulosis in kidney recipients with polycystic kidney disease. Transplant Proc. 2007;39(4):1054-1056.; Qasabian RA, Meagher AP, Lee R, Dore GJ, Keogh A. Severe diverticulitis after heart, lung, and heart-lung transplantation. J Heart Lung Transplant. 2004;23(7):845-849.; Biondo S, Trenti L, Elvira J, Golda T, Kreisler E. Outcomes of colonic diverticulitis according to the reason of immunosuppression. Am J Surg. 2016;212(3):384-390.; Sugrue J, Lee J, Warner C, Thomas S, Tzvetanov I, Mar W, et al. Acute diverticulitis in renal transplant patients: should we treat them differently? Surgery. 2018;163(4):857-865.; Hall J, Hardiman K, Lee S, Lightner A, Stocchi L, Paquette IM, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum. 2020;6:728-747.; Samdani T, Pieracci FM, Eachempati SR, Benarroch-Gampel J, Weiss A, Pietanza MC, et al. Colonic diverticulitis in chemotherapy patients: should operative indications change? A retrospective cohort study. Int J Surg. 2014;12(12):1489-1494.; Trenti L, Kreisler E, Galvez A, Golda T, Frago R, Biondo S. Long-term evolution of acute colonic diverticulitis after successful medical treatment. World J Surg. 2015;39(1):266-274.; Wasvary H, Turfah F, Kadro O, Beauregard W. Same hospitalization resection for acute diverticulitis. Am Surg [Internet]. 1999;65(7):632-635; discussion 636. Available from. http://www.ncbi.nlm.nih.gov/pubmed/10399971.; Kaiser AM, Jiang J-K, Lake JP, Ault G, Artinyan A, Gonzalez-Ruiz C, et al. The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol [Internet]. 2005;100(4):910-917. Available from. http://www.ncbi.nlm.nih.gov/pubmed/15784040.; von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg [Internet]. 2014;12(12):1495-1499. Available from. https://linkinghub.elsevier.com/retrieve/pii/S174391911400212X.; Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-213.; Scotti A, Santangelo M, Federico S, Carrano R, La Tessa C, Carlomagno N, et al. Complicated diverticulitis in kidney transplanted patients: analysis of 717 cases. Transplant Proc. 2014;46(7):2247-2250.; Biondo S, Ramos E, Fraccalvieri D, Kreisler E, Ragué JM, Jaurrieta E. Comparative study of left colonic peritonitis severity score and Mannheim peritonitis index. Br J Surg. 2006;93(5):616-622.; Vetter D, Schuurmans MM, Benden C, Clavien P-A, Nocito A. Long-term follow-up of lung transplant recipients supports non-operative treatment of uncomplicated diverticulitis. Clin Transplant. 2016;30(10):1264-1270.; Sartelli M, Weber DG, Kluger Y, Ansaloni L, Coccolini F, Abu-Zidan F, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020;15(1):1-18.; Francis NK, Sylla P, Abou-Khalil M, Arolfo S, Berler D, Curtis NJ, et al. EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice. Surg Endosc [Internet]. 2019;33(9):2726-2741. Available from:. https://doi.org/10.1007/s00464-019-06882-z.; Nagata N, Ishii N, Manabe N, Tomizawa K, Urita Y, Funabiki T, et al. Guidelines for colonic diverticular bleeding and colonic diverticulitis: Japan gastroenterological association. Digestion. 2019;99(Suppl 1):1-26.; Al-Khamis A, Abou Khalil J, Demian M, Morin N, Vasilevsky C-A, Gordon PH, et al. Sigmoid colectomy for acute diverticulitis in immunosuppressed vs immunocompetent patients. Dis Colon Rectum [Internet]. 2016;59(2):101-109. Available from. https://journals.lww.com/00003453-201602000-00003.; McKechnie T, Lee Y, Kruse C, Qiu Y, Springer JE, Doumouras AG, et al. Operative management of colonic diverticular disease in the setting of immunosuppression: a systematic review and meta-analysis. Am J Surg [Internet]. 2020;221(1):72-85. Available from:. https://doi.org/10.1016/j.amjsurg.2020.06.035.; Klarenbeek BR, Samuels M, van der Wal MA, van der Peet DL, Meijerink WJ, Cuesta MA. Indications for elective sigmoid resection in diverticular disease. Ann Surg. 2010;251(4):670-674.; Fowler H, Gachabayov M, Vimalachandran D, Clifford R, Orangio GR, Bergamaschi R. Failure of nonoperative management in patients with acute diverticulitis complicated by abscess: a systematic review. Int J Colorectal Dis. 2021;36(7):1367-1383.; Vaghiri S, Prassas D, Knoefel WT, Krieg A. Surgical management in immunosuppressed patients with sigmoid diverticulitis, still a challenge: a single-center observational study. Int J Colorectal Dis [Internet]. 2022;37(8):1909-1917. Available from:. https://doi.org/10.1007/s00384-022-04226-3.; Tartaglia D, Cremonini C, Annunziata E, Catena F, Sartelli M, Kirkpatrick AW, et al. Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (web-based international register of emergency surgery and trauma, Wires-T). Tech Coloproctol. 2023;27:747-757.; Biondo S, Borao JL, Kreisler E, Golda T, Millan M, Frago R, et al. Recurrence and virulence of colonic diverticulitis in immunocompromised patients. Am J Surg. 2012;204(2):172-179. |
| Contributed Indexing: | Investigator: MM Díez; A Timoteo; J Trueta; S Salvans; RE Medina; T Gómez; L Fernández-Vega; E Peña; JM García-González; F Blanco-Antona; AI Fábregues; E Sagarra; E Viejo; A Moreno; A Ballestero; A Muriel; ÁL Del Rey; T Díaz; A Etxart; M Del Mar Olmedo; C Nuño; M Kraft; A Vivas; P Peláez; I Alonso; Á Santana; D Surgery; M González-Bermúdez; C González-Prado; V Jiménez-Carneros; B Laiz; D Moro; L Delgado; I Gallarín; C Vera; O Delisau; B Montcusí; D Serralta; Á García-Granero; PA Parra; JA Alcázar; F Mauri; R Ríos; ML de FuenMayor; P Abadía; EM Torres; GP Ibero; A Echeveste-Varela; CS Unit; N Chavarrías; N Ortega-Torrecilla; E Ferrero; D Surgery; E Iglesias; M Otero; T Llamero; C Lévano; A Benitez; J Revuelta; MI Lavado; B Matías; L Cornejo; A Navarro; JA Rojo; N Alonso; C Giménez; EÁ Diego; C Pérez-González; A Zarco; E de San Pío; P Ortega; J López-Ruiz; Keywords: diverticulitis; immunosuppressed; non-operative management |
| Entry Date(s): | Date Created: 20231127 Date Completed: 20240129 Latest Revision: 20250709 |
| Update Code: | 20260130 |
| DOI: | 10.1111/codi.16810 |
| PMID: | 38010046 |
| Database: | MEDLINE |
Journal Article