Zoe Garoufalia interviews Dale Vimalachandran about the DAMASCUS study ahead of ESCP's next Global Reach webinar 'Myths and Evidence in Diverticular Disease'.

Dale Vimalachandran is a consultant colorectal surgeon at the Countess of Chester in Northwest England and Associate Professor at the University of Liverpool. He runs a research group at the University of Liverpool which is exploring the local and systemic responses of advanced colorectal cancer to neoadjuvant therapy. He also has a research interest in diverticular disease and is one of the lead investigators for the global DAMASCUS study. Dale has been the chief investigator for a number of other research studies including the HiP study which compared low Hartman’s procedure to intersphincteric APE in low rectal cancer along with the ReCaP study which looked at rectal cancer management during the Covid pandemic. He is one of the current Royal College of Surgeons/ACPGBI sub-specialty leads for colorectal surgical research and is also the NIHR national specialty lead for surgical oncology.

Zoe Garoufalia: Mr Vimalachandran thank you for agreeing to this interview about myths and evidence in diverticular disease. Diverticular disease is a common problem affecting up to 65% of people aged over 80 years old. Despite its high incidence, treatment of diverticulitis is not the same universally. One of the most recent studies about treatment of acute diverticulitis is the DAMASCUS trial.

Could you briefly inform us about the DAMASCUS trial?

Dale Vimalachandran: Many thanks for the invitation to discuss the DAMASCUS study. This was developed to investigate a common colorectal condition for which there appears to be significant variation in treatment and outcomes both nationally and internationally. The aims of the study are to assess these variations and specifically to try and determine if there are any patient/disease factors that may predict failure of conservative management in an acute attack.

ZG: Do you have any preliminary data from the trial to share with the ESCP audience?

DV: DAMASCUS is still ongoing and is due to recruit the final patient in August, with the final 6-month follow up completing in February 2022. To date we have recruited over 3700 from 249 centres across 40 countries. We hope to be able to share some baseline demographic data with the audience in June.

ZG: How is DAMASCUS going to change current practice regarding management of acute diverticulitis?

DV: I think acute diverticulitis is an area where there is a real gap in quality, prospective data with most studies being retrospective and often single centre. DAMASCUS will be the first study to gather prospective data globally and really start to explore the reasons behind the different outcomes between countries. We hope that with such a large dataset we may be able to detect a signal that identifies those (small group) of patients that might be better served by surgical rather than conservative treatment. We are also keen to explore clinician equipoise for future randomised interventional studies. We know that RCT’s in diverticular disease can be very difficult to recruit, so we hope this information might help with future trial design in acute diverticulitis.

ZG: How does global collaboration affect the treatment of colorectal disease?

DV: From what the current data suggest there appears to be significant global variation in the treatment and outcomes from acute diverticulitis. DAMASCUS will for the first time explore this prospectively. The findings from this study will hopefully start to flatten this variation and ensure that outcomes as a whole across the world start to improve for patients with this disease.

ZG: Do you have any messages to convey to the young ESCP surgeons around the world, regarding upcoming developments in diverticular disease diagnosis and treatment?

DV: Only to say thank you to all those who have taken part in the study, you may be interested that we are collaborating with Mr Frank McDermott and are running a translational sub-study to look at the epigenetic changes associated with acute diverticulitis. In the future we hope that such information may provide further data about individual risk of recurrent disease and symptoms. We very much hope that in the near future we can launch follow up studies both qualitative and interventional based on the DAMASCUS dataset.

ZG: Thank you for your time and insights.

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