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The European Association for Endoscopic Surgery (EAES) Guidelines Committee presents its 2024 recommendations on the surgical management of complicated diverticulitis and complete mesocolic excision (CME) for right-sided colon cancer. Guideline development involves a rigorous process, including topic selection based on member survey, protocol development, and stakeholder engagement. A multidisciplinary team, adhering to GRADE methodology, conducts systematic reviews and meta-analyses.
For complicated diverticulitis, a network meta-analysis informed recommendations favoring primary anastomosis over Hartmann's procedure and lavage in terms of stoma-free survival, with similar mortality rates. However, evidence certainty was low to moderate. Patient preferences and cost-effectiveness analysis supported primary anastomosis. Conditional recommendations were issued based on patient factors and surgeon expertise.
For CME, the analysis of RCTs and cohort studies demonstrated improved overall survival compared to standard resection, with no significant differences in other outcomes. Despite low to moderate evidence certainty, a conditional recommendation for CME was issued where expertise is available.
Both guidelines highlight the importance of balancing benefits and harms, considering patient preferences, and addressing implementation challenges. The full guidelines will be available in September 2024, with detailed discussions in Surgical Endoscopy.