American College of Physicians Issues Guideline on Colonoscopy and Interventions to Prevent Recurrence After Acute Left-sided Diverticulitis
Douglas K. Rex, MD, MASGE, reviewing Qaseem A, et al. Ann Intern Med 2022 Jan 18.
This guideline from the American College of Physicians appears with a summary of the supporting literature review and has 3 recommendations:
- Colonoscopy should be performed after an initial episode of complicated left-sided colonic diverticulitis if no recent colonoscopy has been performed (conditional recommendation; low-certainty evidence).
- Mesalamine does not prevent recurrent diverticulitis and, therefore, is not recommended for this purpose (strong recommendation; high-certainty evidence).
- Elective surgery should be discussed with patients after an initial episode of complicated diverticulitis, or following persistent or frequently recurring episodes of uncomplicated diverticulitis. The decision of whether or not to proceed with surgery should be personalized.
COMMENTThe most important distinction here from current practice is that the evidence was interpreted to support colonoscopy only after episodes of complicated diverticulitis. However, screening colonoscopy would certainly be warranted after uncomplicated diverticulitis in persons aged 45 years or older with no prior colonoscopy.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, Fitterman N, Shamliyan T, Wilt TJ; Clinical Guidelines Committee of the American College of Physicians. Colonoscopy for diagnostic evaluation and interventions to prevent recurrence after acute left-sided colonic diverticulitis: a clinical guideline from the American College of Physicians. Ann Intern Med 2022 Jan 18. (Epub ahead of print) (https://doi.org/10.7326/m21-2711)
