Evidence map›Paper›PMID 27686365›Full record

Trial reportThe British journal of surgery2017

Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis.

L Daniels, Ç Ünlü, N de Korte, S van Dieren, H B Stockmann, B C Vrouenraets, E C Consten, J A van der Hoeven, Q A Eijsbouts, I F Faneyte and 4 more

2 registry-linked trialsOpen access · greenAbstract readMulticenter StudyPragmatic Clinical TrialRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The British journal of surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 126 papers, 18 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
126citing papers in PubMed, 18 pooled it
31.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01111253 phase4unknown statusnot on this map

DIABOLO Trial: A Multicenter Randomized Clinical Trial Investigating the Cost-effectiveness of Treatment Strategies With or Without Antibiotics for Uncomplicated Acute Diverticulitis.

TypeinterventionalSponsorAcademisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)Ran2010 to 2014Enrolled533ConditionsDiverticulitisArmsAmoxicillin-clavulanate
NCT07492134 phase2recruitingnot on this mapstarted 2026, after this paper: background citation

Comparing Placebo Versus Antibiotics for Acute Uncomplicated Diverticulitis

TypeinterventionalSponsorVanderbilt University Medical CenterRan2026 to 2028Enrolled100ConditionsAcute Uncomplicated DiverticulitisArmsAmoxicillin-Clavulanate 875 Mg-125 Mg Oral Tablet, Placebo, Metronidazole, Cefuroxime
3 · Its place in the literature

Who cites it

126 citing papers in PubMed, 18 syntheses or guidelines pooled it, 308 citations in OpenAlex.

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  9. Antibiotics for uncomplicated diverticulitis.The Cochrane database of systematic reviews · 2022
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66 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 20 institutions in 3 countries.

L DanielsDepartment of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Ç ÜnlüDepartment of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
N de KorteSpaarne Gasthuis Hospital, Hoofddorp, The Netherlands.
S van DierenClinical Research Unit, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
H B StockmannSpaarne Gasthuis Hospital, Haarlem, The Netherlands.
B C VrouenraetsDepartment of Surgery, Onze Lieve Vrouwe Gasthuis West, Amsterdam, The Netherlands.
E C ConstenMeander Medical Centre, Amersfoort, The Netherlands.
J A van der HoevenAlbert Schweitzer Hospital, Dordrecht, The Netherlands.
Q A EijsboutsSpaarne Gasthuis Hospital, Hoofddorp, The Netherlands.
I F FaneyteZiekenhuisgroep Twente Hospital, Almelo, The Netherlands.
W A BemelmanDepartment of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
M G DijkgraafClinical Research Unit, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
M A BoermeesterDepartment of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Dutch Diverticular Disease (3D) Collaborative Study Group
University of Amsterdam · NLRed Cross Hospital · GRSpaarne Ziekenhuis · NLRadboud University Nijmegen · NLSint Franciscus Gasthuis · NLSlotervaartziekenhuis · NLAlbert Schweitzer Hospital · GAGelre Hospitals · NLIkazia Ziekenhuis · NLSpaarne Gasthuis · NLSt. Antonius Ziekenhuis · NLZiekenhuis Groep Twente · NLMeander Medisch Centrum · NLOLVG · NLTergooi · NLUniversity Medical Center Utrecht · NLWestfriesgasthuis · NLMedisch Centrum Alkmaar · NLReinier de Graaf Hospital · NLRijnstate Hospital · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAntibiotics are advised in most guidelines on acute diverticulitis, despite a lack of evidence to support their routine use. This trial compared the effectiveness of a strategy with or without antibiotics for a first episode of uncomplicated acute diverticulitis.

methodsPatients with CT-proven, primary, left-sided, uncomplicated, acute diverticulitis were included at 22 clinical sites in the Netherlands, and assigned randomly to an observational or antibiotic treatment strategy. The primary endpoint was time to recovery during 6 months of follow-up. Main secondary endpoints were readmission rate, complicated, ongoing and recurrent diverticulitis, sigmoid resection and mortality. Intention-to-treat and per-protocol analyses were done.

resultsA total of 528 patients were included. Median time to recovery was 14 (i.q.r. 6-35) days for the observational and 12 (7-30) days for the antibiotic treatment strategy, with a hazard ratio for recovery of 0·91 (lower limit of 1-sided 95 per cent c.i. 0·78; P = 0·151). No significant differences between the observation and antibiotic treatment groups were found for secondary endpoints: complicated diverticulitis (3·8 versus 2·6 per cent respectively; P = 0·377), ongoing diverticulitis (7·3 versus 4·1 per cent; P = 0·183), recurrent diverticulitis (3·4 versus 3·0 per cent; P = 0·494), sigmoid resection (3·8 versus 2·3 per cent; P = 0·323), readmission (17·6 versus 12·0 per cent; P = 0·148), adverse events (48·5 versus 54·5 per cent; P = 0·221) and mortality (1·1 versus 0·4 per cent; P = 0·432). Hospital stay was significantly shorter in the observation group (2 versus 3 days; P = 0·006). Per-protocol analyses were concordant with the intention-to-treat analyses.

conclusionObservational treatment without antibiotics did not prolong recovery and can be considered appropriate in patients with uncomplicated diverticulitis. Registration number: NCT01111253 (http://www.clinicaltrials.gov).

Indexed as

Watchful WaitingAcute DiseaseAmoxicillin-Potassium Clavulanate CombinationAnti-Bacterial AgentsColon, SigmoidDiverticulitis, ColonicFemaleHumansLength of StayMaleMiddle AgedNetherlandsPatient ReadmissionRecovery of FunctionTomography, X-Ray ComputedVisual Analog ScaleAmoxicillin-Potassium Clavulanate CombinationAnti-Bacterial Agents

Identifiers

PMID27686365
OpenAlexW2525803483

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.