Controversies in Guidelines for the Treatment of Abdominal Abscesses in Acute Diverticulitis: An Umbrella Review

Background: This systematic umbrella review aims to investigate whether provide an analysis of guidelines regarding the treatment of diverticular abscesses summarizing the evidences from the best available practice. Material and methods: A systematic literature search was performed until using the Cochrane Overviews of Reviews model for search the ‘Clinical Practice Guidelines’; at the end of initial search only 12 guidelines, whose characteristics are reported in the following table were included in this analysis. The quality of the guidelines was assessed by adopting the 2017 updated version of the “Appraisal of Guidelines for Research and Evaluation II” (AGREE II). The comparative analysis of these guidelines has highlighted the presence of some differences regarding the recommendations on the treatment of diverticular abscesses. In particular, there are some controversies about the diameter of abscess to be used in order to decide between medical treatment and percutaneous drainage. Different guidelines propose different abscess diameter cutoffs, such as 3 cm, 4-5 cm, or 4 cm, for distinguishing between small and large abscesses. Conclusions: Currently, a lot of scientific societies recommend that diverticular abscesses with diameters larger than 3 cm should be considered for percutaneous drainage whereas abscesses with diameters smaller than 3 cm could be appropriately treated by medical therapy with antibiotics; only, few guidelines, suggest the use of percutaneous drainage for abscess with a diameter greater than 4 cm .The difference among guidelines is the consequence of the different selection of scientific evidences. In conclusion, our evaluation has revealed the importance of seeking new scientific evidence with higher quality to either confirm, reinforce or potentially weaken the existing recommendations from different societies.