Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2021; 13(3): 82-89
Published online Mar 16, 2021. doi: 10.4253/wjge.v13.i3.82
Post-colonoscopy diverticulitis: A systematic review
Zi Qin Ng, Jih Huei Tan, Henry Chor Lip Tan, Mary Theophilus
Zi Qin Ng, Mary Theophilus, Department of General Surgery, St John of God Midland Hospital, Midland 6056, Western Australia, Australia
Jih Huei Tan, Henry Chor Lip Tan, Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru 80100, Johor, Malaysia
Mary Theophilus, Curtin Medical School, Curtin University, Bentley 6102, Western Australia, Australia
Author contributions: Ng ZQ contributed study design, collected and analyzed data, drafted manuscript; Tan JH and Tan HCL collected and analyzed data and reviewed manuscript; Theophilus M contributed co-designed study, analyzed data and critical review of manuscript; all authors approved final version of manuscript to be published.
Conflict-of-interest statement: The authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zi Qin Ng, MBBS (Hons), General Surgery Trainee, Department of General Surgery, St John of God Midland Hospital, 1 Clayton Street, Midland 6056, Western Australia, Australia. kentng@hotmail.co.uk
Received: December 3, 2020
Peer-review started: December 3, 2020
First decision: December 31, 2020
Revised: December 31, 2020
Accepted: February 12, 2021
Article in press: February 12, 2021
Published online: March 16, 2021
Processing time: 95 Days and 21 Hours
Abstract
BACKGROUND

Post-colonoscopy diverticulitis is increasingly recognized as a potential complication. However, the evidence is sparse in the literature.

AIM

To systematically review all available evidence to describe the incidence, clinical course with management and propose a definition.

METHODS

The databases PubMed, EMBASE and Cochrane databases were searched using with the keywords up to June 2020. Additional manual search was performed and cross-checked for additional references. Data collected included demographics, reason for colonoscopy, time to diagnosis, method of diagnosis (clinical vs imaging) and management outcomes.

RESULTS

A total of nine studies were included in the final systematic review with a total of 339 cases. The time to diagnosis post-colonoscopy ranged from 2 h to 30 d. Clinical presentation for these patients were non-specific including abdominal pain, nausea/vomiting, per rectal bleeding and chills/fever. Majority of the cases were diagnosed based on computed tomography scan. The management for these patients were similar to the usual patients presenting with diverticulitis where most resolve with non-operative intervention (i.e., antibiotics and bowel rest).

CONCLUSION

The entity of post-colonoscopy diverticulitis remains contentious where there is a wide duration post-procedure included. Regardless of whether this is a true complication post-colonoscopy or a de novo event, early diagnosis is vital to guide appropriate treatment. Further prospective studies especially registries should include this as a complication to try to capture the true incidence.

Keywords: Colonoscopy; Diverticulitis; Complication; Management; Antibiotics; Surgery

Core Tip: The entity of post-colonoscopy diverticulitis is a rare complication. However, there is no consensus on its definition especially on the duration included post-procedure. It could well represent a de novo event or exacerbation of subacute condition. Regardless, it should be considered as a differential in patients presenting with abdominal pain post-colonoscopy and managed according to the usual treatment of patients presenting with diverticulitis.