TY - JOUR
T1 - Systematic review and meta-analysis on key controversies in the management of diverticular disease
T2 - a multi-society collaboration
AU - Huo, Bright
AU - Dourado, Justin
AU - Khaldi, Maher Al
AU - Ntaga, Iro
AU - Broderick, Joe
AU - Shehata, Dena
AU - Calabrese, Elisa
AU - Lingam, Gita
AU - de Sadeleer, Anse
AU - Barbera, Elizabeth
AU - Reinke, Caroline
AU - Carrano, Francesco
AU - Breukink, Stephanie
AU - Kaiser, Andreas
AU - Marafini, Irene
AU - Biffl, Walter
AU - Catena, Fausto
AU - Frizelle, Frank
AU - Doulias, Triantafyllos
AU - Tursi, Antonio
AU - Kimble, James
AU - Buchenholz, Nicole
AU - Walls, Sophie
AU - Yao, Xiaomei
AU - Guyatt, Gordon
AU - Yiasemidou, Marina
AU - Heuvelings, Danique
AU - Garfinkle, Richard
AU - Abou-Khalil, Maria
AU - Slater, Bethany J.
AU - Antoniou, Stavros A.
AU - Bouvy, Nicole
AU - Sylla, Patricia
AU - Francis, Nader
AU - Boutros, Marylise
PY - 2026/9/1
Y1 - 2026/9/1
N2 - Background We performed a systematic review & meta-analysis to inform the development of a multi-society guideline on the management of diverticular disease.Methods We identified randomized trials and cohort studies addressing five key questions for patients with symptomatic uncomplicated diverticular disease (SUDD), uncomplicated diverticulitis, and complicated diverticulitis. Our panel established outcomes and decision thresholds. Two reviewers performed screening by title and abstract and full-text, data extraction, and risk of bias appraisal. We applied a random-effects meta-analysis and appraised the certainty of the evidence per GRADE.Results We identified 27 studies from 5,449 articles. For KQ3, patients with recurrent symptomatic uncomplicated diverticulitis experienced an improvement in quality of life at 2 years [standardized mean difference of 0.53, 95% CI (0.30-0.76), clinically significant effect, low certainty] and a reduced rate of disease recurrence at 1 year [286 fewer per 1,000, 95% CI (350 fewer to 124 fewer), large effect, low certainty] with elective surgery vs. surveillance. For KQ4, when compared to a traditional screening cohort, patients with an initial episode of uncomplicated diverticulitis undergoing colonoscopy did not have a significantly different rate of detecting advanced adenomas [37 more per 1,000, 95% CI (18 more to 60 more), trivial effect, low certainty] and uncertainty in the impact on detecting colorectal cancers [1 more per 1,000, 95% CI (2 fewer to 7 more), trivial effect, very low certainty]. For KQ5, patients with diverticulitis complicated by an abscess experienced a reduction in recurrence at 1 year [198 fewer per 1,000, 95% CI (206 fewer to 186 fewer), small effect, moderate certainty] and no difference in 30-day mortality [10 more per 1,000, 95% CI (0 fewer to 68 more), trivial effect, moderate certainty] with elective surgery vs. surveillance.Conclusion This systematic review illustrates contemporary evidence and research gaps in the management of patients with diverticular disease.
AB - Background We performed a systematic review & meta-analysis to inform the development of a multi-society guideline on the management of diverticular disease.Methods We identified randomized trials and cohort studies addressing five key questions for patients with symptomatic uncomplicated diverticular disease (SUDD), uncomplicated diverticulitis, and complicated diverticulitis. Our panel established outcomes and decision thresholds. Two reviewers performed screening by title and abstract and full-text, data extraction, and risk of bias appraisal. We applied a random-effects meta-analysis and appraised the certainty of the evidence per GRADE.Results We identified 27 studies from 5,449 articles. For KQ3, patients with recurrent symptomatic uncomplicated diverticulitis experienced an improvement in quality of life at 2 years [standardized mean difference of 0.53, 95% CI (0.30-0.76), clinically significant effect, low certainty] and a reduced rate of disease recurrence at 1 year [286 fewer per 1,000, 95% CI (350 fewer to 124 fewer), large effect, low certainty] with elective surgery vs. surveillance. For KQ4, when compared to a traditional screening cohort, patients with an initial episode of uncomplicated diverticulitis undergoing colonoscopy did not have a significantly different rate of detecting advanced adenomas [37 more per 1,000, 95% CI (18 more to 60 more), trivial effect, low certainty] and uncertainty in the impact on detecting colorectal cancers [1 more per 1,000, 95% CI (2 fewer to 7 more), trivial effect, very low certainty]. For KQ5, patients with diverticulitis complicated by an abscess experienced a reduction in recurrence at 1 year [198 fewer per 1,000, 95% CI (206 fewer to 186 fewer), small effect, moderate certainty] and no difference in 30-day mortality [10 more per 1,000, 95% CI (0 fewer to 68 more), trivial effect, moderate certainty] with elective surgery vs. surveillance.Conclusion This systematic review illustrates contemporary evidence and research gaps in the management of patients with diverticular disease.
KW - Diverticulitis
KW - SUDD
KW - Colorectal surgery
KW - Minimally invasive surgery
KW - Laparoscopic surgery
KW - Systematic review
KW - Guidelines
KW - RANDOMIZED CLINICAL-TRIAL
KW - DOUBLE-BLIND
KW - OPEN-LABEL
KW - MULTICENTER
KW - RIFAXIMIN
KW - EFFICACY
KW - COLONOSCOPY
KW - COLON
KW - ANTIBIOTICS
KW - RECURRENCE
U2 - 10.1007/s00464-026-13297-0
DO - 10.1007/s00464-026-13297-0
M3 - Article
SN - 0930-2794
JO - Surgical endoscopy and other interventional techniques
JF - Surgical endoscopy and other interventional techniques
ER -