Routine colonoscopy after left-sided acute uncomplicated diverticulitis: a systematic review.

The use of routine colonoscopy after an episode of acute diverticulitis (AD) remains a point of debate. Most international and clinical practice guidelines advise endoscopy after conservatively treated diverticulitis. The rationale has always been to exclude an underlying malignancy or advanced colonic neoplasia (ACN). However, this is based merely on expert opinion. A recent article indicated that presently this may be different with increased use of abdominal CT imaging of diverticulitis. Furthermore, the yield of colonoscopy in patients after an episode of AD also casts doubt on current international practice. Routine colonoscopy after an uncomplicated episode of diverticulitis dates from a time where the diagnosis was primarily based on clinical examination and laboratory results with frequent use of barium enema. However, in today’s clinical practice, CT is widely used for the diagnosis of diverticulitis, with the possibility to assess potential adverse events such as abscess, fistula, obstruction, or perforation as well. Because of high sensitivity of 94%, a specificity of 99%, and a low interobserver variability, this modality is currently preferred for the diagnosis of diverticulitis, although US also has a good sensitivity. Nevertheless, it remains uncertain if the prevalence of colorectal carcinoma (CRC) and advanced adenoma (AA) in patients with imaging-proven diverticulitis is higher than in an average-risk population. Apart from diagnosing CRC, the detection of AA is of great importance because it bears the potential to progress to carcinoma. Colonoscopy is accompanied by such disadvantages as invasiveness and discomfort, potential adverse events such as perforation, and additional costs. It is important