Systematic review and meta-analysis on key controversies in the management of diverticular disease: a multi-society collaboration
In brief
Elective surgery reduces 1-year recurrence by about 20% in diverticulitis with abscess
A meta-analysis of 27 studies found that patients with diverticulitis complicated by an abscess who underwent elective surgery had roughly 200 fewer recurrences per 1,000 patients after one year, with no increase in 30-day mortality. Similar benefits were seen for recurrent uncomplicated disease, while routine colonoscopy after a first uncomplicated episode showed only trivial gains in detecting advanced adenomas. Evidence certainty ranged from low to moderate, highlighting remaining gaps.
- Journal
- Surgical endoscopy (Q1)
- Published
- 1 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Bright Huo, Justin Dourado, Maher Al Khaldi, Iro Ntaga, Joe Broderick, Dena Shehata, et al.
- PMID
- 42684446
- DOI
- 10.1007/s00464-026-13297-0
Why clinicians should know about it
- Picked for Epidemiology (top studies of the week, 6 September 2026): Systematic review of diverticular disease management controversies
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.