Diagnosis and treatment of diverticular disease - Results of a consensus development conference

Background: With the aim of resolving the current controversy over the diag nosis and treatment of diverticular disease, this consensus development con ference set out to summarize the actual state of the art. Methods: A multidisciplinary panel of international experts (n = 16) was se lected to take part in the consensus process. Prior to the conference, all experts were asked to answer a series of questions on diverticular disease. The consensus statement compiled out of these evaluations was modified dur ing a joint meeting of the panel members, then presented for discussion in a public session, and finally revised by the expert panel. The finalized st atement was mailed to all panel members for approval (Delphi method). Results: Asymptomatic diverticulosis, diverticular disease (with actual or recurrent symptoms), and complicated diverticular disease were defined sepa rately. No agreement was reached on whether barium enema or colonoscopy is the better choice as an initial diagnostic tool in uncomplicated cases. In complicated cases, computed tomography is recommended for diagnosis. After two attacks of diverticular disease, elective resection should be considere d. For patients in whom a concomitant carcinoma cannot be excluded and thos e with chronic complications (fistula, stenosis, or bleeding) surgery is al so indicated. Laparoscopic sigmoid colectomy is recommended only for uncomp licated and, after percutaneous drainage of abscesses, Hinchey stage I and II cases. Conclusions: Laparoscopic surgery has already begun to influence the manage ment of diverticular disease, but the randomized controlled trials needed t o support therapy decisions are largely missing.