Routine colonoscopy is not required in uncomplicated diverticulitis: a systematic review

It is generally accepted that patients following an episode of diverticulitis should have additional colonoscopy screening to rule out a colorectal malignancy. We aimed to investigate the rate of CRC found by colonoscopy after an attack of uncomplicated diverticulitis. MEDLINE, Embase, and Cochrane databases were searched systematically for clinical trials or observational studies on colonic evaluation by colonoscopy after the initial diagnosis of acute uncomplicated diverticulitis, followed by hand-searching of reference lists. Nine studies met the inclusion criteria and included a total number of 2,490 patients with uncomplicated diverticulitis. Subsequent colonoscopy after an episode of uncomplicated diverticulitis was performed in 1,468 patients (59 %). Seventeen patients were diagnosed with CRC, having a prevalence of 1.16 % (95 % confidence interval 0.72-1.9 % for CRC). Hyperplastic polyps were seen in 156 patients (10.6 %), low-grade adenoma in 90 patients (6.1 %), and advanced adenoma was reported in 32 patients (2.2 %). Unless colonoscopy is regarded for screening in individuals aged 50 years and older, routine colonoscopy in the absence of other clinical signs of CRC is not required.