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CompletedNCT03146091MUDUpdated Aug 18, 2022

Outpatient Treatment of Uncomplicated Diverticulitis With Either Antibiotic or Nonantibiotic Treatment

An interventional study of Nonantibiotic treatment of uncomplicated diverticulitis and Antibiotic treatment of uncomplicated diverticulitis in Uncomplicated Diverticular Disease, sponsored by Jewish General Hospital. Completed at 1 site in Canada. Open to participants aged 18 Years to 90 Years. Per ClinicalTrials.gov, last updated 2022-08-18.

Sponsored by Jewish General Hospital · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
33
Allocation
Randomized
Ages
18 Years to 90 Years
Sex
All
01

Study summary

Uncomplicated sigmoid diverticulitis is a common disease in Western countries. Traditional management includes inpatient administration of either oral or intravenous antibiotics with resumption of oral intake as symptoms improve. Recent literature has however questioned both inpatient and antibiotic treatment. Indeed, both inpatient and antibiotic treatment are associated with non-negligible risks to patients. The aim of this trial is to assess the feasibility of a randomized controlled trial designed to determine whether nonantibiotic treatment of uncomplicated diverticulitis is safe in the outpatient setting.

Read the detailed description

Uncomplicated sigmoid diverticulitis is a common disease in Western countries. Traditional management includes inpatient administration of either oral or intravenous antibiotics with resumption of oral intake as symptoms improve. Recent literature has however questioned both inpatient and antibiotic treatment. Indeed, both inpatient and antibiotic treatment are associated with non-negligible risks to patients. The aim of this trial is to assess the feasibility of a randomized controlled trial designed to determine whether nonantibiotic treatment of uncomplicated diverticulitis is safe in the outpatient setting. It is designed as a pilot non-inferiority blinded randomized controlled trial. The estimated length of this pilot trial is 1 year. The target population is capable adults of who have a CT-diagnosed episode of uncomplicated diverticulitis who present to the Jewish General Hospital Emergency room.

02

Conditions studied

  • Uncomplicated Diverticular Disease

Keywords

  • Antibiotics
03

Who can participate

Ages eligible
18 Years to 90 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Age ≥ 18 and \< 90 years old
  2. Capable of giving informed consent
  3. Lower abdominal pain and/or tenderness
  4. Confirmed affection of left colon, including descending and sigmoid colon
  5. Confirmed episode of acute uncomplicated diverticulitis on computed tomography (CT) scan defined as wall edema with or without fat stranding. Limited pericolic air with bubbles less than 5 mm in size, and less than 5cm from the colon wall, will be included as uncomplicated diverticulitis. Scan must be performed prior to enrollment and assessment for illegibility. The initial scan is not a study-specific procedure.

Exclusion criteria

Exclusion Criteria:

  1. CT scan shows complicated diverticulitis as defined by the presence of intraperitoneal free perforation (i.e. intraperitoneal contrast extravasation if intra-rectal contrast given, free air under diaphragms, disseminated intraperitoneal air), abscess, obstruction, fistulisation, and phlegmon.
  2. Suspicion of colorectal cancer on CT scan
  3. Immunosuppression (including but not exclusively insulin-dependent diabetes mellitus, chronic liver disease, ongoing chemotherapy, chronic renal failure with hemodialysis, corticosteroid and immunosuppressive medication)
  4. Pregnancy and breastfeeding
  5. Any comorbid infection requiring
  6. High fever (≥ 38.5 ºC)
  7. Significant leukocytosis (> 15 g/dL)
  8. Abdominal pain worsening in the emergency, impeding ambulation and/or eating
  9. Evidence of generalized peritonitis on physical exam
  10. Intolerance to oral intake and/or persistent vomiting
  11. Marked abdominal distension and/or signs of ileus on CT scan
  12. Noncompliance/unreliability for return visits/lack of support system
  13. Failed outpatient treatment not previously included in study within last 30 days
  14. Cognitive, social or psychiatric impairment
  15. For patients aged 65 years or older, a Charlson Comorbidity Score ≥ 5 as calculated on the following website: https://www.thecalculator.co/health/Charlson-Comorbidity-Index-(CCI)-Calculator-765.html 19-20.
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
33 participants (actual)

Study arms

  • Experimental
    Outpatient nonantibiotic treatment

    Other: Nonantibiotic treatment of uncomplicated diverticulitis

  • Active comparator
    Outpatient antibiotic treatment

    Other: Antibiotic treatment of uncomplicated diverticulitis

Interventions

  • OtherNonantibiotic treatment of uncomplicated diverticulitis

    Patients randomized to this arm will be treated without antibiotics in the outpatient setting. Pain will be managed with appropriate analgesia as per protocol.

  • OtherAntibiotic treatment of uncomplicated diverticulitis

    Patients randomized to this arm will be treated with antibiotics in the outpatient setting. Pain will be managed with appropriate analgesia as per protocol.

05

What researchers measure

Primary outcomes

  1. Participants' retention rate as assessed by the number of participants retained in the study from screening to the end of follow-up.

    The primary outcome pertains to the feasibility of a non-inferiority randomized controlled trial. The study group's main concern is that accrual will be impeded by the important change in clinical management that nonantibiotic treatment of uncomplicated diverticulitis requires. Also, the study group is concerned that patients may be lost to follow-up. For these reasons, the primary outcome is the retention rate of patients from screening to the end of follow-up. The rate will be calculated according to (1) the proportion of participants screened but not randomized, and (2) the proportion of participants lost to follow-up.

    Time frame: 1 year

Secondary outcomes

  1. Treatment failure

    Treatment failure is defined as persistence, increase or recurrence of abdominal pain and/or fever, inflammatory bowel obstruction, need for radiological abscess drainage or immediate surgery due to complicated diverticulitis, need for hospital admission, and mortality during the first 60 days after discharge.

    Time frame: 1 year

06

Study locations

1 site
  • Jewish General Hospital
    Montreal, Quebec H3T 1E2, Canada
07

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

08

Registry details

Key details

Study ID
NCT03146091
Lead sponsor
Jewish General Hospital
Responsible party
Dr. Marylise Boutros (Colorectal Surgery Attending Staff, Assistant Professor of Surgery at McGill University, Jewish General Hospital) — Principal investigator
First posted
May 9, 2017
Start date
May 20, 2017
Primary completion
Dec 30, 2019
Completion
Dec 30, 2020
Last update
Aug 18, 2022

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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