Interview by Zoe Garoufalia.
Introduction by the authors Johannes Schultz and Eva Angenete.
Dr Johannes Schultz is colorectal surgeon at the Department of Gastrointestinal Surgery in Akershus University Hospital, Lørenskog, Norway. Eva Angenete is Professor of Surgery, combined with a position as a colorectal consultant at the Sahlgrenska University Hospital.
Diverticular disease is a common condition and a frequent concern for colorectal surgeons, with acute diverticulitis as one of the most common reasons for emergency admissions to colorectal units. Unfortunately, there is a very inconsistent use of terminology in various publications on diverticular disease, making communication about the disease difficult. There are several national guidelines in ESCP member states, few of them recently updated. Several longstanding paradigms in the management of diverticular disease have been challenged in recent years, namely antibiotic treatment, prophylactic surgery, resection surgery in perforated diverticulitis and routine follow-up colonoscopy. This highlights the need of a pan European agreement on terminology, treatment and follow-up of diverticular disease.
Dr Johannes Schultz, colorectal surgeon at the Department of Gastrointestinal Surgery in Akershus University Hospital, Norway, gives us a brief introduction to the new guidelines:
The rapid development of imaging modalities has improved the diagnostic accuracy, but at the same time may have led to a stage migration, as air bubbles or small abscesses can be visualised more easily. Simultaneously, the development of mini-invasive treatment alternatives has increased the therapeutic options in diverticular disease. Several high quality publications on implementation of these novel modalities have originated from ESCP member states, frequently with ESCP members as primary investigators.
The ESCP guideline committee has invited many European experts to participate in this guideline project. One of the main objectives at the start of the project was to agree on definitions for the subgroups of diverticular disease. This is crucial to secure a clear communication. In this respect, the current guideline has a major advantage compared to the recently published diverticulitis guidelines both by EAES/SAGES and by ASCRS where there is no clear definition of the subgroups of diverticular disease and diverticulitis. The ESCP approach to guidelines includes a democratic Delphi process where all experts participate. This ensures that the interpretation of scientific data as well as the evaluation of expert opinions have been scrutinised and reviewed several times before the statements have been accepted and agreed upon. Taken together, this makes the guidelines useful for members, a help in everyday practice. This guideline will also provide the possibility for the members of ESCP to benchmark their treatment of diverticulitis to a European standard.
Dr Stéphanie Breukink, Assistant Chair of ESPC’s Guidelines Committee notes:
“As ESCP guideline committee we are very pleased to see the outcome of this very important pan European work. It gives a clear and up-to-date guidance for different subgroups of patients suffering from this very common colorectal disease”