Cristián Gallardo interviews Soo Young Lee from Chonnam National University Hwasun Hospital in Korea in the run-up to ESCP's next Global Reach webinar 'Myths and Evidence in Diverticular Disease'.

Soo Young Lee is Assistant Professor, Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, South Korea. He was educated at Seoul National University College of Medicine and Graduate School of Medicine. He had fellowships at Seoul National University Bundang Hospital and Chonnam National University Hwasun Hospital. Before taking up his current position, he was Clinical Assistant Professor, Colorectal Surgery at Chonnam National University Hwasun Hospital.

Colonic diverticular disease is known to be a common disease in western countries, but to be relatively rare in eastern countries. Nevertheless, due to recent improvements in diagnostic methods, increases in the geriatric population, and westernisation of diet, the incidence of diverticular disease in Asians, including Koreans, has been shown to be on the rise. In western countries, diverticular disease occurs more in the left colon, particularly, in the sigmoid colon, while in Asia, it occurs more in the right colon. This highlights the need for a Korean agreement on management of diverticular disease.

Cristián Gallardo: Firstly, let me say it is a pleasure to interview you about the new Korean guidelines on diverticular disease.

To introduce this topic to our readers and according to your research, can you briefly tell us what are the main purposes of the new Korean guidelines on diverticular disease?

Soo Young Lee: It is a great honour to have a chance to tell you about the Korean diverticulitis guidelines. In fact, the name of the guidelines is ‘Clinical Practice Guidelines for the Management of Right Colonic Diverticulitis’, which means it focuses on ‘right-sided’ diverticulitis.
The guidelines aim to present a standard medical recommendation for the diagnosis and treatment of patients with right-sided colonic diverticulitis, through thorough scientific analysis of research published so far.

CG: 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. What approach did you use in Korea?

SYL: The Korean guidelines were developed by de novo method, and the systematic review used in the development followed the methodology presented by Cochrane. The assessment of evidence level and decision of recommendation grade accepted GRADE methodology. The recommendations were finalised through the internal committee review process and the external review process, incluing a public hearing through the Annual Meeting of Korean Society of Coloproctology (KSCP) and a Delphi process by external expert members. We also included the results of the patient's value and preference survey for each individual item in the recommendation.
The guidelines have already been published in Korean language as a booklet and distributed to members of the KSCP.

CG: There have been longstanding paradigms in the management of diverticular disease that have been challenged in recent years, namely antibiotic treatment, prophylactic surgery, resection surgery in perforated diverticulitis and routine follow-up colonoscopy. Do you think the new Korean guidelines will address these issues?

SYL: The guidelines, of course, contain all of the above issues, including the need for antibiotic treatment, route (IV or oral) and duration of antibiotic treatment, conservative treatment in complicated diverticulitis, surgical method (stoma formation, oncologic surgery) in emergency surgery, elective surgery after recovery from conservative treatment, follow-up CT and colonoscopy, and treatment in recurrent diverticulitis.

CG: Taking into account the higher rate of right-sided diverticular disease in Asian countries such as Korea and the lack of special reference to this problem in western guidelines on diverticular disease, Do you believe this new guideline should address this problem, particularly?

SYL: As I have already said, the Korean guidelines focused on right colonic diverticulitis. In fact, there were not many studies on right-sided colonic diverticulitis, so we had a lot of difficulty creating the guidelines because of lack of evidence. However, I think it is significant that this is the first guideline regarding right colonic diverticulitis.

CG: Finally, what are the key take home points to know about this subject?

SYL: As you know, most of the guidelines so far dealt with left colonic diverticulitis. However, the clinical course of right colonic diverticulitis, which occurs frequently in Asian countries, is quite different from left colonic diverticulitis. The Korean Guidelines on Right Colonic Diverticulitis is believed to be a good reference in determing the treatment of right-sided colonic diverticulitis.

CG: Thank you so much for sharing your knowledge with us.

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