International, Expert-Based, Consensus Statement Regarding the Management of Acute Diverticulitis

IMPORTANCE: This Delphi study provides consensus related to many aspects of acute diverticulitis and identifies other areas in need of research. OBJECTIVE: To generate an international, expert-based, consensus statement to address controversies in the management of acute diverticulitis. DESIGN, SETTING, AND PARTICIPANTS: This study was conducted using the Delphi technique from April 3 through October 21, 2014. A survey website was used and a panel of acute diverticulitis experts was formed via the snowball method. The top 5 acute diverticulitis experts in 5 international geographic regions were identified based on their number of publications related to acute diverticulitis. INTERVENTIONS: The Delphi study used 3 rounds of questions, after which the consensus statement was collated. MAIN OUTCOMES AND MEASURES: A consensus statement related to the management of acute diverticulitis. RESULTS: Twenty items were selected for inclusion in the consensus statement following 3 rounds of questioning. A clear definition of uncomplicated and complicated diverticulitis is provided. In uncomplicated diverticulitis, consensus was reached regarding appropriate laboratory and radiological evaluation of patients as well as nonsurgical, surgical, and follow-up strategies. A number of important topics, including antibiotic treatment, failed to reach consensus. In addition, consensus was reached regarding many nonsurgical and surgical treatment strategies in complicated diverticulitis. CONCLUSIONS AND RELEVANCE: Controversy continues internationally regarding the management of acute diverticulitis. This study demonstrates that there is more nonconsensus among experts than consensus regarding most issues, even in the same region. It also provides insight into the status quo regarding the treatment of acute diverticulitis and provides important direction for future research.