Systematic review and meta-analysis on key controversies in the management of diverticular disease: a multi-society collaboration.

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.