Search Results; Study Design, Arm Details, Baselines, and Quality

Ethan M. Balk; Gaelen P. Adam; Wangnan Cao; Kristin Danko; Monika Reddy Bhuma; Shivani Mehta; Ian J. Saldanha; Michael D. Beland; Nishit Shah

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Balk EM, Adam GP, Cao W, et al. Management of Colonic Diverticulitis [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Oct. (Comparative Effectiveness Review, No. 233.)

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Management of Colonic Diverticulitis [Internet].

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Appendix CSearch Results; Study Design, Arm Details, Baselines, and Quality

Search Results

This figure shows the literature flow of the citations related to studies included in the review. The searches from electronic databases (Medline, Embase, Cochrane, CINAHL, and ClinicalTrials.gov) retrieved 15,199 citations. Of these, 14,47 were excluded in abstract screening. The reference lists of 97 systematic reviews and clinical practice guidelines were also screened. Of the 722 articles and records assessed in full text, 632 articles and records were excluded for a variety of reasons. These included being a systematic review (n=93, not including 2 included systematic reviews), single group study for elective surgery with <500 participants (n=59), no specific intervention (n=54), duplicate publication with no unique data (n=50), CT study with no clinical outcomes (n=45), no intervention of interest (n=44), surgery for acute diverticulitis (n=36), not available, which were mostly conference abstracts (n=34), single group studies of acute interventions with <100 participants (n=31), not colonic diverticulitis (n=25), ClinicalTrials.gov record with no results posted (n=21), single group study with no harms data (n=20), nonrandomized comparative study of a treatment with crude results data only (n=20), not primary study or systematic review (n=20), intervention before 1990 (n=14), single group study of colonoscopy with <200 participants (n=13), no outcome of interest (n=13), nonrandomized comparative study of treatment with <30 participants per group (n=12), single group study of CT with <100 (n=11), non-CT diagnostic test (n=7), no analysis of interest (n=6), CT of prediagnosed groups, not for diagnosis or staging (n=1), randomized controlled trial with <10 participants per arm (n=1), antibiotics used for both complicated and uncomplicated diverticulitis, not separated (n=1). Ultimately, we included 77 primary studies (in 88 records) and 2 systematic reviews. Key question 1 (on CT) had 2 systematic reviews and 6 studies. Key question 2a (on hospitalization) had 6 studies. Key question 2b (on antibiotics) had 13 studies in 19 records. Key question 2c (on interventional radiology) had 2 studies. Key question 3 (on colonoscopy) had 20 studies. Key question 4a and b (on nonsurgical prevention treatments) had 12 studies in 13 records. Key question 4c (on elective surgery) had 18 studies in 22 records.

Figure C-1Literature flow diagram

Abbreviations: CPG = clinical practice guideline, CT = computed tomography (imaging), KQ = Key Question, NCT = ClinicalTrials.gov record, NRCS = nonrandomized comparative study, SR = systematic review.

* These systematic reviews do not include the two included for Key Question 1.

† CT of prediagnosed groups, not for diagnosis or staging (N=1), randomized controlled trial, N<10/arm (N=1), antibiotics used for both complicated and uncomplicated diverticulitis, not separated (N=1)

Included Studies

Key Question 1 (CT Imaging)

Andeweg, C. S.; Knobben, L.; Hendriks, J. C.; Bleichrodt, R. P.; van Goor, H. How to diagnose acute left-sided colonic diverticulitis: proposal for a clinical scoring system. Ann Surg. PMID 21346548 [PubMed: 21346548]
Jurowich, C. F.; Jellouschek, S.; Adamus, R.; Loose, R.; Kaiser, A.; Isbert, C.; Germer, C. T.; von Rahden, B. H. How complicated is complicated diverticulitis?--phlegmonous diverticulitis revisited. Int J Colorectal Dis. PMID 21830036. [PubMed: 21830036]
Kelly ME, Heeney A, Redmond CE, Costelloe J, Nason GJ, Ryan J, Brophy D, Winter DC. Incidental findings detected on emergency abdominal CT scans: a 1-year review. Abdom Imaging. 2015 Aug;40(6):1853–7. doi: 10.1007/s00261-015-0349-4. PMID 25576049 [PubMed: 25576049] [CrossRef]
Martin Arevalo, J.; Garcia-Granero, E.; Garcia Botello, S.; Munoz, E.; Cervera, V.; Flor Lorente, B.; Lledo, S. [Early use of CT in the management of acute diverticulitis of the colon]. Rev Esp Enferm Dig. PMID 17883294 [PubMed: 17883294]
Salem, T. A.; Molloy, R. G.; O’Dwyer, P. J. Prospective study on the role of the CT scan in patients with an acute abdomen. Colorectal Dis. PMID 16108882 [PubMed: 16108882]
Shuaib W, Johnson JO, Salastekar N, Maddu KK, Khosa F. Incidental findings detected on abdomino-pelvic multidetector computed tomography performed in the acute setting. Am J Emerg Med. 2014 Jan;32(1):36–9. PMID 24475484 [PubMed: 24475484]

Key Question 2a (Outpatient)

Biondo, S.; Golda, T.; Kreisler, E.; Espin, E.; Vallribera, F.; Oteiza, F.; Codina-Cazador, A.; Pujadas, M.; Flor, B. Outpatient versus hospitalization management for uncomplicated diverticulitis: a prospective, multicenter randomized clinical trial (DIVER Trial). Ann Surg. PMID 23732265 [PubMed: 23732265]
Bolkenstein, H. E.; Draaisma, W. A.; van de Wall, B.; Consten, E.; Broeders, I. Treatment of acute uncomplicated diverticulitis without antibiotics: risk factors for treatment failure. Int J Colorectal Dis. PMID 29679152 [PMC free article: PMC6002463] [PubMed: 29679152]
Joliat, G. R.; Emery, J.; Demartines, N.; Hubner, M.; Yersin, B.; Hahnloser, D. Antibiotic treatment for uncomplicated and mild complicated diverticulitis: outpatient treatment for everyone. Int J Colorectal Dis. PMID 28664347 [PubMed: 28664347]
Lorente, L.; Cots, F.; Alonso, S.; Pascual, M.; Salvans, S.; Courtier, R.; Gil, M. J.; Grande, L.; Pera, M. Outpatient treatment of uncomplicated acute diverticulitis: Impact on healthcare costs. Cir Esp. PMID 23764519 [PubMed: 23764519]
Moya, P.; Arroyo, A.; Perez-Legaz, J.; Serrano, P.; Candela, F.; Soriano-Irigaray, L.; Calpena, R. Applicability, safety and efficiency of outpatient treatment in uncomplicated diverticulitis. Tech Coloproctol. PMID 22706731 [PubMed: 22706731]
Unlu, C.; Gunadi, P. M.; Gerhards, M. F.; Boermeester, M. A.; Vrouenraets, B. C. Outpatient treatment for acute uncomplicated diverticulitis. Eur J Gastroenterol Hepatol. PMID 23636075 [PubMed: 23636075]

Key Question 2b (Antibiotics)

AVOD.
Chabok, A.; Pahlman, L.; Hjern, F.; Haapaniemi, S.; Smedh, K. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. PMID 22290281 [PubMed: 22290281]
AVOD.
Isacson. Long-term follow-up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis. Br J Surg. PMID 31386199 [PubMed: 31386199]
DIABOLO.
Daniels, L.; Unlu, C.; de Korte, N.; van Dieren, S.; Stockmann, H. B.; Vrouenraets, B. C.; Consten, E. C.; van der Hoeven, J. A.; Eijsbouts, Q. A.; Faneyte, I. F.; Bemelman, W. A.; Dijkgraaf, M. G.; Boermeester, M. A. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg. PMID 27686365 [PubMed: 27686365]
DIABOLO.
Juncadella and Anna C.; Feuerstein andJoseph D. In uncomplicated, left-sided acute diverticulitis, observation did not differ from antibiotics for recovery. Annals of Internal Medicine. PMID 28241291 [PubMed: 28241291]
DIABOLO.
van Dijk, S. T.; Daniels, L.; de Korte, N.; Stockmann, H. B.; Vrouenraets, B. C.; EC, J. Consten; JA, B. van der Hoeven; Faneyte, I. F.; MG, W. Dijkgraaf; Boermeester, M. A. Quality of Life and Persistent Symptoms After Uncomplicated Acute Diverticulitis. Dis Colon Rectum. PMID 30807455 [PubMed: 30807455]
DIABOLO.
van Dijk, S. T.; Daniels, L.; Unlu, C.; de Korte, N.; van Dieren, S.; Stockmann, H. B.; Vrouenraets, B. C.; Consten, E. C.; van der Hoeven, J. A.; Eijsbouts, Q. A.; Faneyte, I. F.; Bemelman, W. A.; Dijkgraaf, M. G.; Boermeester, M. A. Long-Term Effects of Omitting Antibiotics in Uncomplicated Acute Diverticulitis. Am J Gastroenterol. PMID 29700480 [PubMed: 29700480]
AVOD and DIABOLO (individual-patient data meta-analysis).
van Dijk ST, Chabok A, Dijkgraaf MG, et al. Observational versus antibiotic treatment for uncomplicated diverticulitis: an individual-patient data meta-analysis. The British journal of surgery. PMID: 32073652. [PMC free article: PMC7318319] [PubMed: 32073652]
Schug-Pass trial.
Schug-Pass, C.; Geers, P.; Hugel, O.; Lippert, H.; Kockerling, F. Prospective randomized trial comparing short-term antibiotic therapy versus standard therapy for acute uncomplicated sigmoid diverticulitis. Int J Colorectal Dis. PMID 20140619 [PubMed: 20140619]
Schug-Pass trial.
Schug-Pass C.; Geers P.; Hugel O.; Lippert H.; Kockerling F. Erratum: prospective randomized trial comparing short-term antibiotic therapy versus standard therapy for acute uncomplicated sigmoid diverticulitis (International Journal of Colorectal Disease DOI: 10.1007/s00384-010-0899-4). Int J Colorectal Dis. 2010 Jun;25(6):785. No PMID [PubMed: 20140619]
STAND.
Jaung R, Nisbet S, Gosselink MP, et al. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clinical Gastroenterology and Hepatology. PMID: 32240832. [PubMed: 32240832]
de Korte, N.; Kuyvenhoven, J. P.; van der Peet, D. L.; Felt-Bersma, R. J.; Cuesta, M. A.; Stockmann, H. B. Mild colonic diverticulitis can be treated without antibiotics. A case-control study. Colorectal Dis. PMID 21689302 [PubMed: 21689302]
Etzioni; D. A.; Chiu; V. Y.; Cannom; R. R.; Burchette; R. J.; Haigh; P. I.; Abbas; M. A. Outpatient treatment of acute diverticulitis: rates and predictors of failure. Dis Colon Rectum. PMID 20484998 [PubMed: 20484998]
Hjern, F.; Josephson, T.; Altman, D.; Holmstrom, B.; Mellgren, A.; Pollack, J.; Johansson, C. Conservative treatment of acute colonic diverticulitis: are antibiotics always mandatory?. Scand J Gastroenterol. PMID 17190761 [PubMed: 17190761]
Kellum, J. M.; Sugerman, H. J.; Coppa, G. F.; Way, L. R.; Fine, R.; Herz, B.; Speck, E. L.; Jackson, D.; Duma, R. J. Randomized, prospective comparison of cefoxitin and gentamicin-clindamycin in the treatment of acute colonic diverticulitis. Clin Ther. PMID 1638578 [PubMed: 1638578]
Kim; J. Y.; Park; S. G.; Kang; H. J.; Lim; Y. A.; Pak; K. H.; Yoo; T.; Cho; W. T.; Shin; D. W.; Kim; J. W. Prospective randomized clinical trial of uncomplicated right-sided colonic diverticulitis: antibiotics versus no antibiotics. Int J Colorectal Dis. PMID 31267222 [PubMed: 31267222]
Park; J. H.; Park; H. C.; Lee; B. H. One-day versus four-day antibiotic treatment for acute right colonic uncomplicated diverticulitis: A randomized clinical trial. Turk J Gastroenterol. PMID 31290747 [PMC free article: PMC6629280] [PubMed: 31290747]
Ribas; Y.; Bombardo; J.; Aguilar; F.; Jovell; E.; Alcantara-Moral; M.; Campillo; F.; Lleonart; X.; Serra-Aracil; X. Prospective randomized clinical trial assessing the efficacy of a short course of intravenously administered amoxicillin plus clavulanic acid followed by oral antibiotic in patients with uncomplicated acute diverticulitis. Int J Colorectal Dis. PMID 20526718 [PubMed: 20526718]
Ridgway, P. F.; Latif, A.; Shabbir, J.; Ofriokuma, F.; Hurley, M. J.; Evoy, D.; O’Mahony, J. B.; Mealy, K. Randomized controlled trial of oral vs intravenous therapy for the clinically diagnosed acute uncomplicated diverticulitis. Colorectal Dis. PMID 19016815 [PubMed: 19016815]
Scarpa, C. R.; Buchs, N. C.; Poncet, A.; Konrad-Mugnier, B.; Gervaz, P.; Morel, P.; Ris, F. Short-term Intravenous Antibiotic Treatment in Uncomplicated Diverticulitis Does Not Increase the Risk of Recurrence Compared to Long-term Treatment. Ann Coloproctol. PMID 25960972 [PMC free article: PMC4422987] [PubMed: 25960972]

Key Question 2c (Interventional Radiology)

Lambrichts; D. P. V.; Bolkenstein; H. E.; van der Does; Dche; Dieleman; D.; Crolla; Rmph; Dekker; J. W. T.; van Duijvendijk; P.; Gerhards; M. F.; Nienhuijs; S. W.; Menon; A. G.; de Graaf; E. J. R.; Consten; E. C. J.; Draaisma; W. A.; Broeders; Iamj; Bemelman; W. A.; Lange; J. F. Multicentre study of non-surgical management of diverticulitis with abscess formation. Br J Surg. PMID 30811050 [PMC free article: PMC6593757] [PubMed: 30811050]
Mali, J.; Mentula, P.; Leppaniemi, A.; Sallinen, V. Determinants of treatment and outcomes of diverticular abscesses. World J Emerg Surg. PMID 31320921 [PMC free article: PMC6615185] [PubMed: 31320921]

Key Question 3 (Colonoscopy)

Alcantar, D.; Rodriguez, C.; Fernandez, R.; Kumar, S.; Junia, C. The necessity of a colonoscopy after an acute diverticulitis event in adults less than 50 years old. Cureus. PMID 31720142 [PMC free article: PMC6823018] [PubMed: 31720142]
Andrade, P.; Ribeiro, A.; Ramalho, R.; Lopes, S.; Macedo, G. Routine Colonoscopy after Acute Uncomplicated Diverticulitis - Challenging a Putative Indication. Dig Surg. PMID 27941344 [PubMed: 27941344]
Brar, M. S.; Roxin, G.; Yaffe, P. B.; Stanger, J.; MacLean, A. R.; Buie, W. D. Colonoscopy following nonoperative management of uncomplicated diverticulitis may not be warranted. Dis Colon Rectum. PMID 24105001 [PubMed: 24105001]
Choi, Y. H.; Koh, S. J.; Kim, J. W.; Kim, B. G.; Lee, K. L.; Im, J. P.; Kim, J. S.; Jung, H. C. Do we need colonoscopy following acute diverticulitis detected on computed tomography to exclude colorectal malignancy?. Dig Dis Sci. PMID 24723071 [PubMed: 24723071]
Daniels, L.; Unlu, C.; de Wijkerslooth, T. R.; Stockmann, H. B.; Kuipers, E. J.; Boermeester, M. A.; Dekker, E. Yield of colonoscopy after recent CT-proven uncomplicated acute diverticulitis: a comparative cohort study. Surg Endosc. PMID 25472747 [PubMed: 25472747]
Elmi, A.; Hedgire, S. S.; Pargaonkar, V.; Cao, K.; McDermott, S.; Harisinghani, M. Is early colonoscopy beneficial in patients with CT-diagnosed diverticulitis?. AJR Am J Roentgenol. PMID 23701063 [PubMed: 23701063]
Horesh, N.; Saeed, Y.; Horesh, H.; Berger, Y.; Speter, C.; Pery, R.; Rosin, D.; Gutman, M.; Zmora, O. Colonoscopy after the first episode of acute diverticulitis: challenging management paradigms. Tech Coloproctol. PMID 27170283 [PubMed: 27170283]
Khoury, T.; Mahamid, M.; Lubany, A.; Safadi, M.; Farah, A.; Sbeit, W.; Mari, A. Underlying Colorectal Cancer Was Rarely Detected After an Episode of Acute Diverticulitis: a Retrospective Analysis of 225 Patients. J Gastrointest Cancer. PMID 30632029 [PubMed: 30632029]
Lahat, A.; Yanai, H.; Menachem, Y.; Avidan, B.; Bar-Meir, S. The feasibility and risk of early colonoscopy in acute diverticulitis: a prospective controlled study. Endoscopy. PMID 17554647 [PubMed: 17554647]
Lau, K. C.; Spilsbury, K.; Farooque, Y.; Kariyawasam, S. B.; Owen, R. G.; Wallace, M. H.; Makin, G. B. Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded?. Dis Colon Rectum. PMID 21904141 [PubMed: 21904141]
Lecleire, S.; Nahon, S.; Alatawi, A.; Antonietti, M.; Chaput, U.; Di-Fiore, A.; Alhameedi, R.; Marteau, P.; Ducrotte, P.; Dray, X. Diagnostic impact of routine colonoscopy following acute diverticulitis: A multicenter study in 808 patients and controls. United European Gastroenterol J. PMID 25083288 [PMC free article: PMC4114119] [PubMed: 25083288]
Meireles, L. C.; Fernandes, S. R.; Ribeiro, L. C.; Velosa, J. Role of endoscopy after an acute episode of diverticulitis: analysis of a cohort of Portuguese patients from a tertiary referral center. Eur J Gastroenterol Hepatol. PMID 26378691 [PubMed: 26378691]
O’Donohoe, N.; Chandak, P.; Likos-Corbett, M.; Yee, J.; Hurndall, K.; Rao, C.; Engledow, A. Follow up colonoscopy may be omissible in uncomplicated left-sided acute diverticulitis diagnosed with CT- a retrospective cohort study. Scientific Reports. PMID 31882879 [PMC free article: PMC6934646] [PubMed: 31882879]
Ramphal, W.; Schreinemakers, J. M.; Seerden, T. C.; Crolla, R. M.; Rijken, A. M.; Gobardhan, P. D. What is the Risk of Colorectal Cancer After an Episode of Acute Diverticulitis in Conservatively Treated Patients?. J Clin Gastroenterol. PMID 26125459 [PubMed: 26125459]
Ramphal, W.; Schreinemakers, J. M. J.; Seerden, T. C. J.; Gobardhan, P. D. Tumour Characteristics of Patients with Colorectal Cancer after Acute Uncomplicated Diverticulitis. Dig Dis. PMID 29945147 [PubMed: 29945147]
Sallinen, V.; Mentula, P.; Leppaniemi, A. Risk of colon cancer after computed tomography-diagnosed acute diverticulitis: is routine colonoscopy necessary?. Surg Endosc. PMID 24178863 [PubMed: 24178863]
Schout, P. J.; Spillenaar Bilgen, E. J.; Groenen, M. J. Routine screening for colon cancer after conservative treatment of diverticulitis. Dig Surg. PMID 23171930 [PubMed: 23171930]
Seoane Urgorri, A.; Zaffalon, D.; Pera Roman, M.; Batlle Garcia, M.; Riu Pons, F.; Dedeu Cusco, J. M.; Pantaleon Sanchez, M.; Bessa Caserras, X.; Barranco Priego, L.; Alvarez-Gonzalez, M. A. Routine lower gastrointestinal endoscopy for radiographically confirmed acute diverticulitis. In whom and when is it indicated?. Rev Esp Enferm Dig. PMID 29900742 [PubMed: 29900742]
Studniarek, A.; Kochar, K.; Warner, C.; Eftaiha, S.; Naffouj, S.; Borsuk, D.; Mellgren, A.; Park, J.; Cintron, J.; Harrison, J. Findings on colonoscopy after diverticulitis: A multicenter review. The American Surgeon. PMID 31908222. [PubMed: 31908222]
Suhardja, T. S.; Norhadi, S.; Seah, E. Z.; Rodgers-Wilson, S. Is early colonoscopy after CT-diagnosed diverticulitis still necessary?. Int J Colorectal Dis. PMID 28035461 [PubMed: 28035461]

Key Questions 4a-b (Prevention, Nonsurgical)

DIVA.
Stollman, N.; Magowan, S.; Shanahan, F.; Quigley, E. M. A randomized controlled study of mesalamine after acute diverticulitis: results of the DIVA trial. J Clin Gastroenterol. PMID 23426454 [PubMed: 23426454]
PREVENT-1.
Kamm. Prevention of Recurrence of Diverticulitis. https://clinicaltrials.gov/show/nct00545740. NCT00545740
PREVENT-2.
Euctr andN. L. The purpose of this study is to determine whether SPD476 is effective in reducing recurrence of diverticulitis. http://www.who.int/trialsearch/trial2.aspx?Trialid=euctr2007-004896-20-nl. NCT00545103
PREVENT-1 & PREVENT-2.
Raskin, J. B.; Kamm, M. A.; Jamal, M. M.; Marquez, J.; Melzer, E.; Schoen, R. E.; Szaloki, T.; Barrett, K.; Streck, P. Mesalamine did not prevent recurrent diverticulitis in phase 3 controlled trials. Gastroenterology. PMID 25038431 [PubMed: 25038431]
PREVENT-1 & PREVENT-2.
Silva Sanchez S. D.; Wan H.; Streck P.; Willshire D.; Raskin J. B. Long-term safety of once-daily multimatrix mesalazine: a pooled clinical trials analysis. Journal of gastroenterology and hepatology (Australia). No PMID
SAG-37 and SAG-51.
Kruis; W.; Kardalinos; V.; Eisenbach; T.; Lukas; M.; Vich; T.; Bunganic; I.; Pokrotnieks; J.; Derova; J.; Kondrackiene; J.; Safadi; R.; Tuculanu; D.; Tulassay; Z.; Banai; J.; Curtin; A.; Dorofeyev; A. E.; Zakko; S. F.; Ferreira; N.; Bjorck; S.; Diez Alonso; M. M.; Makela; J.; Talley; N. J.; Dilger; K.; Greinwald; R.; Mohrbacher; R.; Spiller; R. Randomised clinical trial: mesalazine versus placebo in the prevention of diverticulitis recurrence. Aliment Pharmacol Ther. PMID 28543263 [PMC free article: PMC5518301] [PubMed: 28543263]
Festa, V.; Spila Alegiani, S.; Chiesara, F.; Moretti, A.; Bianchi, M.; Dezi, A.; Traversa, G.; Koch, M. Retrospective comparison of long-term ten-day/month rifaximin or mesalazine in prevention of relapse in acute diverticulitis. Eur Rev Med Pharmacol Sci. PMID 28387885 [PubMed: 28387885]
Kvasnovsky, C. L.; Bjarnason, I.; Donaldson, A. N.; Sherwood, R. A.; Papagrigoriadis, S. A randomized double-blind placebo-controlled trial of a multi-strain probiotic in treatment of symptomatic uncomplicated diverticular disease. Inflammopharmacology. PMID 28528364 [PubMed: 28528364]
Lanas, A.; Ponce, J.; Bignamini, A.; Mearin, F. One year intermittent rifaximin plus fibre supplementation vs. fibre supplementation alone to prevent diverticulitis recurrence: a proof-of-concept study. Dig Liver Dis. PMID 23092785 [PubMed: 23092785]
Mizuki, A.; Tatemichi, M.; Nakazawa, A.; Tsukada, N.; Nagata, H.; Kinoshita, Y. Effects of Burdock tea on recurrence of colonic diverticulitis and diverticular bleeding: An open-labelled randomized clinical trial. Sci Rep. PMID 31043657 [PMC free article: PMC6494891] [PubMed: 31043657]
Parente; F.; Bargiggia; S.; Prada; A.; Bortoli; A.; Giacosa; A.; Germana; B.; Ferrari; A.; Casella; G.; De Pretis; G.; Miori; G. Intermittent treatment with mesalazine in the prevention of diverticulitis recurrence: a randomised multicentre pilot double-blind placebo-controlled study of 24-month duration. Int J Colorectal Dis. PMID 23754545 [PubMed: 23754545]
Tursi, A.; Brandimarte, G.; Daffina, R. Long-term treatment with mesalazine and rifaximin versus rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon. Dig Liver Dis. PMID 12236485 [PubMed: 12236485]
Tursi, A.; Brandimarte, G.; Giorgetti, G. M.; Elisei, W.; Aiello, F. Balsalazide and/or high-potency probiotic mixture (VSL#3) in maintaining remission after attack of acute, uncomplicated diverticulitis of the colon. Int J Colorectal Dis. PMID 17390144 [PubMed: 17390144]

Key Question 4c (Elective Surgery)

Aquina, C. T.; Becerra, A. Z.; Xu, Z.; Justiniano, C. F.; Noyes, K.; Monson, J. R. T.; Fleming, F. J. Population-based study of outcomes following an initial acute diverticular abscess. Br J Surg. PMID 30335195 [PubMed: 30335195]
Bhakta, A.; Tafen, M.; Glotzer, O.; Canete, J.; Chismark, A. D.; Valerian, B. T.; Stain, S. C.; Lee, E. C. Laparoscopic sigmoid colectomy for complicated diverticulitis is safe: review of 576 consecutive colectomies. Surg Endosc. PMID 26275534 [PubMed: 26275534]
Bolkenstein; H. E.; Consten; E. C. J.; van der Palen; J.; van de Wall; B. J. M.; Broeders; Iamj; Bemelman; W. A.; Lange; J. F.; Boermeester; M. A.; Draaisma; W. A. Long-term Outcome of Surgery Versus Conservative Management for Recurrent and Ongoing Complaints After an Episode of Diverticulitis: 5-year Follow-up Results of a Multicenter Randomized Controlled Trial (DIRECT-Trial). Ann Surg. PMID 30247329 [PubMed: 30247329]
Bolkenstein; H. E.; de Wit; G. A.; Consten; E. C. J.; Van de Wall; B. J. M.; Broeders; Iamj; Draaisma; W. A. Cost-effectiveness analysis of a multicentre randomized clinical trial comparing surgery with conservative management for recurrent and ongoing diverticulitis (DIRECT trial). Br J Surg. PMID 30566245 [PubMed: 30566245]
Bordeianou, L.; Cauley, C. E.; Patel, R.; Bleday, R.; Mahmood, S.; Kennedy, K.; Ahmed, K. F.; Yokoe, D.; Hooper, D.; Rubin, M. Prospective Creation and Validation of the PREVENTT (Prediction and Enaction of Prevention Treatments Trigger) Scale for Surgical Site Infections (SSIs) in Patients With Diverticulitis. Ann Surg. PMID 29916880 [PubMed: 29916880]
Ilyas, M. I.; Zangbar, B.; Nfonsam, V. N.; Maegawa, F. A.; Joseph, B. A.; Patel, J. A.; Wexner, S. D. Are there differences in outcome after elective sigmoidectomy for diverticular disease and for cancer? A national inpatient study. Colorectal Dis. PMID 27422847 [PubMed: 27422847]
Lemini andR.; Spaulding andA. C.; Osagiede andO.; Cochuyt andJ. J.; Naessens andJ. M.; Crandall andM.; Cima andR. R.; Colibaseanu andD. T. Disparities in elective surgery for diverticulitis: Identifying the gap in care. Am J Surg. PMID 30878216 [PubMed: 30878216]
Lidor, A. O.; Schneider, E.; Segal, J.; Yu, Q.; Feinberg, R.; Wu, A. W. Elective surgery for diverticulitis is associated with high risk of intestinal diversion and hospital readmission in older adults. J Gastrointest Surg. PMID 20878256 [PubMed: 20878256]
Masoomi, H.; Buchberg, B.; Nguyen, B.; Tung, V.; Stamos, M. J.; Mills, S. Outcomes of laparoscopic versus open colectomy in elective surgery for diverticulitis. World J Surg. PMID 21732208 [PubMed: 21732208]
Moghadamyeghaneh, Z.; Carmichael, J. C.; Smith, B. R.; Mills, S.; Pigazzi, A.; Nguyen, N. T.; Stamos, M. J. A comparison of outcomes of emergent, urgent, and elective surgical treatment of diverticulitis. Am J Surg. PMID 26116319 [PubMed: 26116319]
Novitsky, Y. W.; Sechrist, C.; Payton, B. L.; Kercher, K. W.; Heniford, B. T. Do the risks of emergent colectomy justify nonoperative management strategies for recurrent diverticulitis?. Am J Surg. PMID 18639223 [PubMed: 18639223]
Papageorge; C. M.; Kennedy; G. D.; Carchman; E. H. National Trends in Short-term Outcomes Following Non-emergent Surgery for Diverticular Disease. J Gastrointest Surg. PMID 27120447 [PMC free article: PMC4916196] [PubMed: 27120447]
Pessaux, P.; Muscari, F.; Ouellet, J. F.; Msika, S.; Hay, J. M.; Millat, B.; Fingerhut, A.; Flamant, Y. Risk factors for mortality and morbidity after elective sigmoid resection for diverticulitis: prospective multicenter multivariate analysis of 582 patients. World J Surg. PMID 14639493 [PubMed: 14639493]
Russ, A. J.; Obma, K. L.; Rajamanickam, V.; Wan, Y.; Heise, C. P.; Foley, E. F.; Harms, B.; Kennedy, G. D. Laparoscopy improves short-term outcomes after surgery for diverticular disease. Gastroenterology. PMID 20193685 [PMC free article: PMC3371380] [PubMed: 20193685]
Sheer, A. J.; Heckman, J. E.; Schneider, E. B.; Wu, A. W.; Segal, J. B.; Feinberg, R.; Lidor, A. O. Congestive heart failure and chronic obstructive pulmonary disease predict poor surgical outcomes in older adults undergoing elective diverticulitis surgery. Dis Colon Rectum. PMID 21979190 [PubMed: 21979190]
Silva-Velazco, J.; Stocchi, L.; Costedio, M.; Gorgun, E.; Kessler, H.; Remzi, F. H. Is there anything we can modify among factors associated with morbidity following elective laparoscopic sigmoidectomy for diverticulitis?. Surg Endosc. PMID 26541732 [PubMed: 26541732]
Simianu; V. V.; Sinanan; M. N.; Bastawrous; A. L.; Billingham; R. P.; Fichera; A.; Florence; M. G.; Herzig; D. O.; Johnson; E. K.; Steele; S. R.; Thirlby; R. C.; Flum; D. R. The impact of delaying elective resection of diverticulitis on laparoscopic conversion rate. Am J Surg. PMID 25773308 [PMC free article: PMC4426006] [PubMed: 25773308]
Tsilimparis, N.; Haase, O.; Wendling, P.; Kipfmuller, K.; Schmid, M.; Engemann, R.; Schwenk, W. [Laparoscopic ‘fast-track’ sigmoidectomy for diverticulitis disease in Germany. Results of a prospective quality assurance program]. Dtsch Med Wochenschr. PMID 20812161 [PubMed: 20812161]
Valizadeh, N.; Suradkar, K.; Kiran, R. P. Specific Factors Predict the Risk for Urgent and Emergent Colectomy in Patients Undergoing Surgery for Diverticulitis. Am Surg. PMID 30747633 [PubMed: 30747633]
van de Wall, B. J. M.; Stam, M. A. W.; Draaisma, W. A.; Stellato, R.; Bemelman, W. A.; Boermeester, M. A.; Broeders, Iamj; Belgers, E. J.; Toorenvliet, B. R.; Prins, H. A.; Consten, E. C. J. Surgery versus conservative management for recurrent and ongoing left-sided diverticulitis (DIRECT trial): an open-label, multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol. PMID 28404008 [PubMed: 28404008]
Varma, S.; Mehta, A.; Canner, J. K.; Azar, F.; Efron, D. T.; Efron, J.; Safar, B.; Sakran, J. V. Surgery After an Initial Episode of Uncomplicated Diverticulitis: Does Time to Resection Matter?. J Surg Res. PMID 30527478 [PubMed: 30527478]
You, K.; Bendl, R.; Taut, C.; Sullivan, R.; Gachabayov, M.; Bergamaschi, R. Randomized clinical trial of elective resection versus observation in diverticulitis with extraluminal air or abscess initially managed conservatively. Br J Surg. PMID 29683483 [PubMed: 29683483]

Study Design Details and Arms, Risk of Bias

Key Question 1 (CT Imaging)

Table C-1-1KQ 1. Description

Study, PMID	Country, Years	Eligibility Criteria	Signs/Symptoms	Imaging	Diagnostic Criteria
Andeweg 2011 21346548	Netherlands 2002–06	Hospitalized with acute abdominal pain, not requiring immediate surgery. CT for “suspected diverticulitis” or “left LLQ pain”.	NR	Abdominal CT	Signs of thickening of the colonic wall of ≥4 mm, with signs of inflammation of the pericolonic fat with or without abscess formation or contained or free perforation.
Jurowich 2011 21830036	Germany 2004–06	Undergoing treatment for diverticulitis of the sigmoid colon	NR	CT, with enema and IV contrast Not all had CT, including some requiring emergency surgery (no imaging) and some with uncomplicated (ultrasound)	Hansen & Stock^*
Kelly 2015 25576049	Ireland 2012	Emergency abdominal CT at a tertiary referral hospital	NR	Abdominal CT, oral contrast	N/A
Martín Arévalo 2007 17883294	Spain NR	Clinical diagnosis of acute diverticulitis	NR	CT, with IV contrast dye if suspected abscess	Hulnick (1984)^†
Salem 2005 16108882	UK 2003–04	Acute abdominal pain, ≥25 yo. Exclude trauma or clear need for laparotomy or selected medical conditions	Acute abdominal pain	CT, with oral and IV contrast	NR
Shuaib 2014 24475484	US 2012	Nontraumatic acute abdominal pain who underwent CT	Acute abdominal pain (not pregnant)	Abdominopelvic CT, oral and/or IV contrast	N/A

: Abbreviations: CT = computed tomography, ESR = erythrocyte sedimentation rate, IV = intravenous, LLQ = (abdominal) left lower quadrant pain, N/A = not applicable (study not restricted to diverticulitis), NR = not reported, PMID = Pubmed identifier, yo = years old.
*: Hansen O, Stock W. [Prophylactic resection in diverticular disease—treatment by precise staging.] Langenbecks Arch Chir Kongressbd. 1999; 116 (Suppl II):1257–60. (No PMID; German)
†: Hulnick DH, Megibow AJ, Balthazar EJ, et al. Computed tomography in the evaluation of diverticulitis. Radiology. 1984;152(2):491–5. doi: 10.1148/radiology.152.2.6739821. PMID: 6739821. [PubMed: 6739821] [CrossRef]

Table C-1-2KQ 1. Population and diagnostic descriptives

Study, PMID

N Analyzed

Female, %

Age

Race

Diagnoses, N

CT Findings^*

Andeweg 2011

21346548

287

62%

≤50 yo: 81%

Diverticulitis, acute left-sided: 124

Other: 163

Surgically managed diverticulitis: TP 31/31

Medically managed diverticulitis: NR

FN 0/163

Jurowich 2011

21830036

318 (total)

242 (fully)

43%

Median 64 (range 26–97)

Diverticulitis 100%

I (uncomplicated, 1^st episode): 30 (9.4%; not further analyzed)

IIA (“phlegmonous”): 112 (35.2%); 83 (34.3%) analyzed

IIB (covered perforation): 84 (26.4%); 78 (32.2%) analyzed

IIC (open perforation): 27 (8.5%); 11.2% of analyzed

III (uncomplicated, recurrent): 54 (17.0%); 22.3% of analyzed

Kelly 2015

25576049

1155

54%

Median 57 (range 16–96)

Diverticulitis: NR

Other: NR

Martín Arévalo 2007

17883294

102

51%

59.4 (15)

Diverticulitis: 84

Other: 18

I (uncomplicated): 60 (59%)

IIa (abscess <3 cm): 8 (7.8%)

IIb (abscess >3 cm): 8 (7.8%)

III (diffuse peritonitis): 8 (7.8%)

Salem 2005

16108882

211

81 w/CT

61%

62.4 (range 27–92)

Diverticulitis: 16

Other: 65

Diverticulitis with abscess: 15/16

Colitis/IBD: 1/16

130 no CT

Diverticulitis: 32

Other: 98

N/A

Shuaib 2014

24475484

290

Diverticulitis: NR

Other: NR

: Abbreviations: CAD = complicated acute diverticulitis, CT = computed tomography, FN = false negative (missed diagnosis of diverticulitis on CT), NR = not reported, PMID = Pubmed identifier, TP = true positive (correct diagnosis of diverticulitis on CT), UAD = uncomplicated acute diverticulitis.
*: Among those with final diagnosis of diverticulitis.

Table C-1-3KQ 1. Quality

Study, PMID	Clear Eligibility Criteria	Adequate Intervention Description	Clear Outcome Definition	Clear Relevant Results
Andeweg 2011 21346548	No (vague)	Yes	No (vague^A)	No (vague^A)
Jurowich 2011 21830036	Yes (but excluded nonsurgical patients from analyses)	No (not all received CT scan)	No (unclear final diagnosis of nonsurgical patients; unclear distinction between Type I (who did not require surgery, per protocol) and Type III (who did require surgery, per protocol)	Yes (for test accuracy); No (to evaluate need for surgery)
Kelly 2015 25576049	Yes (but not restricted to diverticulitis)	Yes	No (vague^B)	No (not clinically oriented^C)
Martín Arévalo 2007 17883294	No (vague)	Yes	Mostly^D	Yes
Salem 2005 16108882	Yes	No (no diagnostic criteria)	Yes	Yes
Shuaib 2014 24475484	Yes (but not restricted to diverticulitis)	Yes	Yes	No (vague^E)

A: Study primarily designed to create a predictive algorithm for diverticulitis diagnosis.
B: Definition of “incidental finding” unclear. E.g., finding of complicated diverticulitis on an emergency abdominal CT was considered incidental.
C: No explanation of the clinical significance of most of the incidental findings.
D: Unclear whether the missed CT diagnoses of colorectal cancer impacted treatment (e.g., type or need for surgery).
E: Focus more on whether radiologists recommended further workup based on incidental findings and whether changes in clinical management occurred. No reporting of specific new incidental findings.

Key Question 2a (Outpatient)

Table C-2a-1KQ 2a. Design details and arms

Study Year PMID Country Funding	Design	N	Population, Diverticulitis Details, Setting	Arm	Arm Details	Age Sex	Prior Episodes Eiverticulitis
Biondo, 2014, 23732265, DIVER Trial, Spain, Non-industry	RCT	132	Uncomplicated diverticulitis, tolerate oral intake with good response to first treatment measures in emergency, willing to continue treatment at home under supervision. Tertiary care, academic	Outpatient management	Discharged after 1st dose of IV Abx in the ED	Mean=55.9 (13.4) 52% male	Mean=0.47 (SD=10.9)
Biondo, 2014, 23732265, DIVER Trial, Spain, Non-industry	RCT	132		Inpatient management	Admitted	Mean=56.8 (12.8) 58% male	Mean=0.39 (SD=1.0)
Bolkenstein, 2018, 29679152, Netherlands, NR	NRCS (Retrospective)	565	First episode uncomplicated diverticulitis, no Abx treatment 2wks prior or 24hr after presentation to hospital Single center	Outpatient management	Not hospitalized within 24hr of presentation	Mean=57 (SD=12) 39% male	None (by design)
Bolkenstein, 2018, 29679152, Netherlands, NR	NRCS (Retrospective)	565		Inpatient management	Hospitalized within 24hr of presentation	Mean=59 (SD=13) 42% male	None (by design)
Joliat, 2017, 28664347, Switzerland, NR	NRCS (Retrospective)	267	Uncomplicated or mild complicated diverticulitis. Single hospital	Outpatient management	Single dose Abx (IV) in ED followed by Abx (oral) for 10 days	Median=53 (Range=44–64) 64% male	None (72%)
Joliat, 2017, 28664347, Switzerland, NR	NRCS (Retrospective)	267		Inpatient management	Abx and fluids (IV), switched to Abx (oral) when pain was managed by non-opioid analgesics and able to tolerate oral medication (also discharged). No alimentary restrictions in hospital	Median=61 (Range=50–72) 50% male	None (71%)
Lorente, 2013, 23764519, Spain, NR	NRCS (Retrospective)	136	Uncomplicated diverticulitis, tolerate oral intake, absence of comorbidities, adequate family or social support. Single hospital	Outpatient management	Abx for 7 days (oral) and analgesia (oral), liquid diet for 2 days. Follow up assessment between 4–7 days after diagnosis to confirm clinical course	Mean=58.75 (SD=15) 44% male	≥1: 19%
Lorente, 2013, 23764519, Spain, NR	NRCS (Retrospective)	136		Inpatient management	Abx (IV) until improvement in symptoms then discharged to continue Abx (oral) at home	Mean=60.52 (SD=19) 43% male	Previous episodes (30%)
Moya, 2012, 22706731, Spain, NR	NRCS (Prospective)	76	Uncomplicated diverticulitis, tolerate oral intake, adequate family and social support network. Academic	Outpatient management	10 d oral Abx, oral analgesics, and dietary restrictions	Median=56.1 (Range=32–83) 50% male	≥1: 16%
Moya, 2012, 22706731, Spain, NR	NRCS (Prospective)	76		Inpatient management	5 d IV Abx, IV analgesic, and dietary restrictions	Median=59.7 (Range=36–84) 45% male	≥1: 18%
Ünlü, 2013, 23636075, Netherlands, NR	NRCS (Retrospective)	312	First episode uncomplicated diverticulitis Two hospitals	Outpatient management	IV Abx in ED, 7–10 d oral Abx	Mean=54.5 (SD=11.1) 42% male	None (by design)
Ünlü, 2013, 23636075, Netherlands, NR	NRCS (Retrospective)	312	First episode uncomplicated diverticulitis Two hospitals	Inpatient management	IV Abx while inpatient, then 7–10 d oral Abx	Mean=59.3 (SD=14.6) 37% male	None (by design)

: Abx = antibiotic, ED = emergency department, mos = month, NR = not reported, NRCS = non-randomized controlled study, OR = odds ratio, PMID = Pubmed identifier, RCT = randomized controlled trial, SD = standard deviation, wk = week.

Table C-2a-2KQ 2a. Risk of bias assessment for primary studies – randomized controlled trials (RCTs)

Study, Year, PMID	Random Sequence Generation	Allocation Concealment	Blinding of Participants	Blinding of Personnel/Care Providers	Blinding of Outcome Assessor (Objective Outcomes)	Blinding of Outcome Assessor (Subjective Outcomes)	Incomplete Outcome Data	Selective Outcome Reporting	Other Bias	Eligibility Criteria Prespecified and Clearly Described	Intervention Clearly Described and Delivered Consistently	Outcomes Prespecified, Clearly Defined, Valid, Reliable, and Assessed Consistently
Biondo, 2014, 23732265	Low	Low	High	High	Low	Low	Low	Unclear	Low	Yes	Yes	Yes

KQ = Key Question, PMID = PubMed Identifier. Ratings are color coded for emphasis only.

From the Cochrane Risk of Bias Tool (each item rated as Low, High, Unclear, or N/A)

Random sequence generation (selection bias): Selection bias (biased allocation to interventions) due to inadequate generation of a randomized sequence;
Allocation concealment (selection bias): Selection bias (biased allocation to interventions) due to inadequate concealment of allocations prior to assignment;
Blinding of participants (performance bias): Performance bias due to knowledge of the allocated interventions by participants during the study;
Blinding of personnel/care providers (performance bias): Performance bias due to knowledge of the allocated interventions by personnel/care providers during the study;
Blinding of outcome assessor (detection bias): Detection bias due to knowledge of the allocated interventions by outcome assessors;
Incomplete outcome data (attrition bias): Attrition bias due to amount, nature or handling of incomplete outcome data;
Selective outcome reporting (outcome reporting bias): Bias arising from outcomes being selectively reported based on the direction and/or strength of the results;
Other Bias: Bias due to problems not covered elsewhere in the table.

From the National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment Tool (each item rated as Yes, No, or Unclear)

Eligibility criteria prespecified and clearly described: potentially related to selection bias;
Intervention clearly described and delivered consistently: potentially related to performance bias;
Outcomes prespecified, clearly defined, valid, reliable, and assessed consistently: potentially related to detection bias.

Table C-2a-3KQ 2a. Risk of bias assessment for primary studies – nonrandomized comparative studies (NRCSs) – assessment of confounding and selection bias

Study, Year, PMID	1.1 Potential for Any Confounding	1.2 Potential for Time-Varying Confounding?	1.4 Appropriate Analysis Method For Confounding?	1.5 Appropriate Confounding Variables Used?	1.6 Inappropriate Control of Post-Intervention Variables?	Judgement – Risk of Bias Related to Confounding	2.1 Participant Selection Based on Post-Intervention Variables?	2.2 Post-intervention Variables Associated With Intervention?	2.3 Post-intervention Variables associated with Outcome?	2.4 Start and Followup (Duration) Coincide	Start and Followup Calendar Years Coincide	2.5 Appropriate Adjustment for Selection Bias	Judgement – Risk of Biase Related to Selection Bias
Bolkenstein, 2018, 29679152	Yes	No	Yes	Unsure	No	Serious	No	N/A	N/A	Yes	No	N/A	Low
Joliat, 2017, 28664347	Yes	No	No	N/A	N/A	Critical	PY	PY	PY	Yes	No	No	Critical
Lorente, 2013, 23764519	Yes	No	No	N/A	N/A	Critical	No	N/A	N/A	Yes	No	N/A	Low
Moya, 2012, 22706731	Yes	Yes	No	N/A	N/A	Critical	No	N/A	N/A	Yes	No	N/A	Low
Ünlü, 2013, 23636075	Yes	No	No	N/A	N/A	Critical	No	N/A	N/A	Yes	No	N/A	Low

: KQ = Key Question, PMID = PubMed Identifier, Responses to Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) signaling questions 1.1 to 1.6 and 2.1 to 2.5 are in regular font. Each item rated as Yes, PY (probably yes), NI (no information), PN (probably no), No, or N/A (not applicable).
: Judgements about confounding and selection bias are in bold font. (each item rated as Low, Moderate, Serious, or Critical).

Key Question 2b (Antibiotics)

Table C-2b-1KQ 2b. Design details

Author, Year, PMID, Study Name, Country, Funder	Study Design	Study Dates	Inclusion Criteria	Exclusion Criteria	How Was Diverticulitis Diagnosed?
AVOD Trial, Sweden, Non-Industry	RCT	2003, 2009	Age 18–75 years, Has at least 2 of following symptoms: fever, abdominal resistance, leukocyte >10,000/μl, CRP (≥20 and ≥ 2 mg/dl), detection of sigmoid diverticulitis using contrast medium. CT evidence, multicenter	CT or other evidence of complicated diverticulitis or other disease, immunosuppressive Tx, pregnancy, ongoing antibiotics
de Korte, 2012, 21689302, Netherlands Not Reported	NRCS (Retrospective)	2001, 2007	Image-confirmed acute mild diverticulitis of the sigmoid colon in which the decision (implied based on review of charts) was made to treat conservatively	NR	image confirmed acute mild based on Ambrosetti or Hinchey 1a criteria
DIABOLO Trial, Sweden, Nonindustry	RCT	2010, 2012	Left-sided uncomplicated acute diverticulitis, clinical and diagnostic (ultrasound or CT) proven, modified Hinchey stages 1a-b (abscess size up to 5 cm) and Ambrosetti’s ‘mild’ diverticulitis stage included.	Previous radiologically proven diverticulitis, higher modified Hinchey stages or Ambrosetti’s ‘severe’ diverticulitis stage, sepsis, antibiotic use in the previous 4 weeks.	Patients were eligible if they had a first episode of left-sided, uncomplicated, acute diverticulitis, confirmed within 24 h by CT.
Etzioni, 2010, 20484998, USA Not Reported	NRCS (Retrospective)	2006, 2007	evaluated in Kaiser Permanente ED for a primary assigned diagnosis of acute diverticulitis, continuously enrolled as a member in Kaiser Permanente system before the index treatment episode	admitted for inpatient treatment, prior diagnosis of diverticulitis, colorectal cancer, inflammatory bowel disease, did not have CT within 1 year of ED evaluation	ICD codes
Hjern, 2007, 17190761, Sweden, Nonindustry	NRCS (Prospective)	2000, 2002	Clinical diagnosis of Acute Diverticulitis confirmed by CT	Diagnoses only based on clinical findings, operated immediately following admission because of clinical signs of peritonitis, perforated AD confirmed by CT	Clinical diagnosis of Acute Diverticulitis confirmed by CT
Jaung, 2019, 32240832, STAND, New Zealand and Australia	RCT	2015–2019	CT-proven Hinchey 1a uncomplicated acute diverticulitis	≥2 criteria for Systemic Inflammatory Response Syndrome (SIRS), temperature <36° or >38° C, heart rate >90 beats per minute, respiratory rate >20 breaths per minute or PaCO3 <32mmHg, white cell count <4 or >12 × 10 9/L); were unable to give consent, language barrier or cognitive impairment; previous drug reactions; prior usage of steroids; had been administered regular immunomodulators or biologics within the six months prior to presentation; used regular NSAIDs for greater than a week prior to presentation; had been administered >1 dose of intravenous or >2 doses of oral antibiotics during this illness but prior to enrolment in the study; were pregnant; had an American Society of Anesthesiologists physical status classification (ASA) ≥4; or had CT evidence of complicated acute diverticulitis.	CT
Kellum, 1992, 1638578, USA Not reported	RCT	NR	Acute diverticulitis considered present if there was abdominal tenderness, signs of infection (fever or leukocytosis), and radiological, surgical or pathological evidence.	Creatinine >/= 3mg/dl	Acute diverticulitis considered present if there was abdominal tenderness, signs of infection (fever or leukocytosis), radiological, surgical or pathological evidence.
Kim, 2019, 31267222, S Korea Not reported	RCT	2014, 2018	(1) age 18–80 years; (2) right-sided colonic diverticulitis (cecum, ascending colon, or proximal transverse colon); and (3) uncomplicated diverticulitis (grade Ia)	(1) age < 18 or > 80 years; (2) distal transverse, left-sided, or sigmoid colonic diverticulitis; (3) complicated colonic diverticulitis (grades Ib, II, III, or IV); (4) sepsis; (5) systemic inflammatory response syndrome (SIRS); (6) immunocompromised patients (taking corticosteroid or immunosuppressive drugs, transplantation, or chronic renal failure with hemodialysis); (7) allergy to quinolone antibiotics; (8) pregnant or lactating patients; (9) American Society of Anesthesiologists (ASA) score > 3; (10) social, psychiatric, or cognitive impairment	Intravenous (IV) contrast–enhanced computed tomography (CT) was performed to confirm the diagnosis. Uncomplicated diverticulitis is defined as grade Ia and complicated diverticulitis includes grades Ib, II, III, and IV.
Park, 2019, 31290747, S Korea, Not Reported	RCT	2011, 2014	Right colonic diverticulitis in emergency or hospital setting, CT proven,	Abscess >3 cm in diameter, Hinchey II diseases or worse, ongoing antibiotic therapy from other hospital, pregnancy, or cephalosporin allergy	Inflamed diverticulum, phlegmon formation (Hinchey Ia), and small (≤3 cm) pericolic abscess formation (partial Hinchey Ib) were considered to be consistent with the diagnosis of CT-based uncomplicated diverticulitis
Ribas, 2010, 20526718, Spain, Non-industry	RCT	NR	Clinical diagnosis of uncomplicated acute diverticulitis, CT confirmed within 28–48 h	(1) immunocompromised patients, (2) patients under 18 years of age, (3) pregnant women, (4) clinical suspicion or CT confirmation of complicated acute diverticulitis, (5) Karnofsky performance score less than 50%, or (6) allergy to penicillin	The clinical diagnosis of sigmoid diverticulitis was suggested in patients with abdominal pain localized to the left lower quadrant and tenderness upon physical examination. The presence of fever, change in bowel habits, dysuria, urinary frequency and urgency, as well as leukocytosis was also taken into account to reach the diagnosis of diverticulitis.
Ridgway, 2008, 19016815, Ireland, Not Reported	RCT	2002, 2004	Acute uncomplicated diverticulitis. Hinchey type 1, multicenter	Hinchey types III or IV	Plain radiology and relevant blood investigation
Scarpa, 2015, 25960972, Switzerland Not Reported	NRCS (Prospective)	2007, 2012	1st episode CT-confirmed uncomplicated diverticulitis requiring hospitalization	complicated diverticulitis (Hinchey-Ib class and above), <18 yrs of age, chronic IBD or a tumor	physical examination and laboratory tests revealing an inflammatory syndrome and was confirmed by using an abdominal CT scan
Schug-Pass, 2010, 20140619, Germany, Industry	RCT	2004, 2008	Sigmoid diverticulitis using contrast medium, CT proven, multi-center	Study Tx or other betalactam. Hypersensitivity to betalactam. Immunosuppressant use. Antibiotic Tx within 2 weeks before enrollment. Incurable hematological/oncological diseases. Pregnancy. Existing sigmoid diverticulitis requiring surgery.

Table C-2b-2KQ 2b. Arm details

Author, Year, PMID, Study Name, Country	Arm	Arm Description	Dose	Frequency	Route	Duration of Intervention
AVOD Trial, Sweden, Non-Industry	Antibiotics: Multiple (discretionary or undefined)	IV combination of a second- or third-generation cephalosporin (cefuroxime or cefotaxime) and metronidazole, or with carbapenem antibiotics (ertapenem, meropenem or imipenem) or piperacillin – tazobactam. Orally administrated antibiotics such as ciprofloxacin or cefadroxil combined with metronidazole were initiated subsequently on the ward or at discharge.	NR	NR	IV	≥ 7 days
AVOD Trial, Sweden, Non-Industry	Placebo	IV fluids only	NR	NR	IV	N/A
de Korte, 2012, 21689302, Netherlands	Antibiotics: Multiple (discretionary or undefined)	Two hospitals, different antibiotic protocols. No formal protocol at H1; antibiotics not routinely given. H2 had protocol for antibiotic treatment of diverticulitis: combination of piperacilin and metronidazole (IV; no doses given) when admitted to surgical ward; amoxicillin–clavulanic acid (IV; no doses given) when admitted to the internal medicine or gastroenterology wards. Continued for 7–10 days depending on clinical status	NR	NR	IV	7–10 days
de Korte, 2012, 21689302, Netherlands	No intervention (non-placebo)	Restriction of oral intake, intravenous fluid rehydration and observation. When symptoms resided, a normal diet was started. No specific foods were avoided. Analgesics were given as appropriate, starting with acetaminophen and nonsteroid anti-inflammatory drugs (NSAIDs) as needed.	NR	NR	NR	NR
DIABOLO Trial, Sweden, Nonindustry	No intervention (non-placebo)	No antibiotic	NR	NR	NR	NR
DIABOLO Trial, Sweden, Nonindustry	Antibiotics: Amoxicillin + Clavulanate	IV amoxicillin–clavulanic acid was chosen as broad-spectrum antibiotic treatment of choice. Was switched to oral administration after 10 days if tolerated. In the event of allergy, a switch was made to the combination of ciprofloxacin and metronidazole.	1200 mg	4/day	IV for 10 days, switched to oral after if tolerated	10 days
Etzioni, 2010, 20484998, USA	Fluoroquinolone + metronidazole	Most commonly used	NR	NR	Oral	N/A
	Antibiotic duration: 14+ days	N/A	N/A	N/A	N/A	N/A
	Antibiotic duration: 10–13 days	N/A	N/A	N/A	N/A	N/A
	Antibiotic duration: <10 days	N/A	N/A	N/A	N/A	N/A
	Multiple (discretionary or undefined)	trimethoprim/sulfamethoxazole, amoxicillin, extended-spectrum beta-lactamases, clindamycin, doxycycline, and cephalosporins	NR	NR	Oral	N/A
Hjern, 2007, 17190761, Sweden	No intervention (non-placebo)	Careful observation, iv fluids, restriction of oral intake, no antibiotics
Hjern, 2007, 17190761, Sweden	Antibiotics: Cephalosporin + Metronidazole	Careful observation, iv fluids, restriction of oral intake, antibiotics			Oral cephalosporine and metronidazole given iv, followed by oral administration of quinolone with metronidazole	10–14 days
Jaung, 2019, 32240832, STAND, New Zealand and Australia	Antibiotics: po amoxicillin/clavulanic +- IV cefuroxime & po metronidazole	Initial regimen (IV cefuroxime 750 mg every 6 hours and oral metronidazole 400 mg three times a day), and oral antibiotics (amoxicillin/clavulanic acid 625 mg three times a day). Use of “IV regimen” at the discretion of the surgical team.	cefuroxime 750 mg; metronidazole 400 mg; amoxicillin/clavulanic acid 625 mg	cefuroxime every 6 hours; oral metronidazole 3 t.i.d; amoxicillin/clavulanic acid t.i.d	first iv and oral, then oral	5–7 days (outpatient after first approximately 2 days)
Jaung, 2019, 32240832, STAND, New Zealand and Australia	Placebo	N/A	N/A	N/A	N/A	5–7 days (outpatient after first approximately 2 days)
Kellum, 1992, 1638578, USA	Antibiotics: Gentamicin-Clindamycin		1 to 1.4 gm	Every 8 hours	IV	NR
Kellum, 1992, 1638578, USA	Antibiotics: Cefoxitin		1 to 2 gm	Every 6 hours	IV	NR
Kim, 2019, 31267222, S Korea	Placebo	Admitted, administered IV fluids, and given bowel rest for at least 3 days (and up to 5 days)
Kim, 2019, 31267222, S Korea	Antibiotics: Cephalosporin + Metronidazole	Antibiotics	Ceftriaxone, 2 g and metronidazole, 500 mg	Ceftriaxone, once daily and metronidazole, three times daily	IV was first used, then changed to oral when oral intake was toleratedIV	10 days
Park, 2019, 31290747, S Korea	Antibiotics: Cephalosporin + Metronidazole	1-day group	Cefmetazole (2000mg/day) and metronidazole (1500 mg/day)		IV	1 day
Park, 2019, 31290747, S Korea	Antibiotics: Cephalosporin + Metronidazole	4-day group	Cefmetazole (2000mg/day) and metronidazole (1500 mg/day)		57 received 4 days of IV; 32 received 3 days of IV and 1 day oralIV	4 day
Ribas, 2010, 20526718, Spain	Antibiotics: Amoxicillin + Clavulanate	antibiotics intravenously administered at first and then orally administered when symptoms improved (pain decrease, less tenderness, and absence of fever)	amoxicillin plus clavulanic acid 1g every 8h	3/day	inpatients (IV+oral) then outpatient (oral)IV	inpatients (IV (1–2 days) + oral (2–3 days)) then outpatient (oral) (10 days)
Ribas, 2010, 20526718, Spain	Antibiotics: Amoxicillin + Clavulanate	antibiotics intravenously administered	amoxicillin plus clavulanic acid 1g every 8h	3/day	inpatients (IV only) then outpatient (oral)IV	inpatients (IV) (8–9 days) then outpatient (oral) (5 days)
Ridgway, 2009, 19016815, Ireland	Antibiotics: Ciprofloxacin + Metronidazole	Oral	500 mg, 400 mg	NR	Conversion to IV as per attending physicianIV
Ridgway, 2009, 19016815, Ireland	Antibiotics: Ciprofloxacin + Metronidazole	IV	400 mg, 500 mg	NR	Conversion to IV as per attending physicianIV
Scarpa, 2015, 25960972, Switzerland	Antibiotics: short course IV	All patients received an IV antibiotic treatment of ceftriaxone (2,000 mg/day) and metronidazole (1,500 mg/day) except when contraindicated. Antibiotic treatment for 5 days or less.	IV: ceftriaxone (2,000 mg/day); metronidazole (1,500 mg/day); oral: ciprofloxacine (1,000-mg/day); metronidazole (1,500-mg/day)	IV: ceftriaxone (2,000 mg/day); metronidazole (1,500 mg/day); oral: ciprofloxacine (1,000-mg/day); metronidazole (1,500-mg/day)	OralIV	up to 5 days for IV (followed by 5 days oral antibiotics) (NB. results report mean length of treatment 4.7 days)
Scarpa, 2015, 25960972, Switzerland	Antibiotics: long course IV	All patients received an IV antibiotic treatment of ceftriaxone (2,000 mg/day) and metronidazole (1,500 mg/day) except when contraindicated. Antibiotic treatment for 6 days, possibly up to 14 days.	ceftriaxone (2,000 mg/day); metronidazole (1,500 mg/day)	ceftriaxone (2,000 mg/day); metronidazole (1,500 mg/day)	IV	6–14 days for IV (NB. results report mean length of treatment 8.7 days)
Schug-Pass, 2010, 20140619, Germany	Antibiotic: Ertapenem	4 days	1 g	1/day	IV	4 days
Schug-Pass, 2010, 20140619, Germany	Antibiotic: Ertapenem	7 days	1 g	1/day	IV	7 days

Table C-2b-3KQ 2b. Baselines

Author, Year, PMID, Study Name, Country	Arm	Male %	Race/Ethnicity	Age, Mean (SD) or %	Participants with Un/Complicated Diverticulitis, %	Number of Prior Episodes of Diverticulitis, %	History of (Prior) Complicated Diverticulitis %	Time Since Last Episode of Diverticulitis, Mean (SD)
AVOD Trial, Sweden	Antibiotics: Multiple (discretionary or undefined)	35	NR	57.4 (12.8)	100/0	at least one episode 35.6	NR	NR
AVOD Trial, Sweden	Placebo (IV fluids only)	36	NR	57.1 (13.2)	100/0	at least one episode 44.8	NR	NR
de Korte, 2012, 21689302, Netherlands	Antibiotics: Multiple (discretionary or undefined)	29	NR	61 [Range 27–92]	0/100	NR	NR	NR
de Korte, 2012, 21689302, Netherlands	No intervention (non-placebo)	46.4	White 94%, Black 3.8%, Hispanic/Latino 16.6%, Asian 0.3%, Other 1.9%	56.1 (11.04)	NR	none 0.5, one 59.7, two 22.7, four to five 5.8, six to ten 1.9	NR	16.5 weeks [range 0, 122 weeks]
DIABOLO Trial, Sweden,	No intervention (non-placebo)	50.6	NR	57.4	NR	NR	NR	NR
DIABOLO Trial, Sweden,	Antibiotics: Amoxicillin + Clavulanate	54.7	NR	59.4 (12.1)	NR	NR	NR	NR
Etzioni, 2010, 20484998, USA	Total	46	NR	58.5	NR	NR	NR	NR
Hjern, 2007, 17190761, Sweden	No intervention (non-placebo)	35	NR	59	NR	NR	30	NR
Hjern, 2007, 17190761, Sweden	Antibiotics: Cephalosporin + Metronidazole	37	NR	60	NR	NR	25	NR
Jaung, 2019, 32240832, STAND, New Zealand and Australia	Antibiotics: po amoxicillin/clavulanic +- IV cefuroxime & oral metronidazole	40	NR	Probably Median 56 (probably IQR 53–59)	0	71	NR	NR
Jaung, 2019, 32240832, STAND, New Zealand and Australia	Placebo	44	NR	Probably Median 59 (probably IQR 57–62)	0	68	NR	NR
Kellum, 1992, 1638578, USA	Antibiotics: Cefoxitin	NR	NR	64.5 (SE 2)	NR	NR	12	NR
Kellum, 1992, 1638578, USA	Antibiotics: Gentamicin-Clindamycin	NR	NR	60.8 (SE 3)	NR	NR	NR	NR
Kim, 2019, 31267222, S Korea	Placebo (admitted, administered IV fluids, and given bowel rest for at least 3 days (and up to 5 days))	57.8	NR	38.9 (9.5)	100/0	NR	NR	NR
Kim, 2019, 31267222, S Korea	Antibiotics: Cephalosporin + Metronidazole	65.6	NR	37.9 (8.4)	100/0	NR	NR	NR
Park, 2019, 31290747, S Korea	Antibiotics: Cephalosporin + Metronidazole (1-day group)	54.0	NR	42.0 (11.1)	100/0	none 100	0	NR
Park, 2019, 31290747, S Korea	Antibiotics: Cephalosporin + Metronidazole (4-day group)	55.1	NR	40.2 (11.2)	100/0	none 100	0	NR
Ribas, 2010, 20526718, Spain	Antibiotics: Amoxicillin + Clavulanate (IV then Oral)	52	NR	56 (95%CI 50, 62)	100/0	Mean 1.2 (95%CI 0.9, 1.5)	NR	NR
Ribas, 2010, 20526718, Spain	Antibiotics: Amoxicillin + Clavulanate (IV)	52	NR	56 (95%CI 45, 57)	100/0	Mean 1.5 (95%CI 0.9, 2.1)	NR	NR
Ridgway, 2009, 19016815, Ireland	Antibiotics: Ciprofloxacin + Metronidazole (Oral)	39.02	NR	Median 68 [Range 31–84]	NR	NR	NR	NR
Ridgway, 2009, 19016815, Ireland	Antibiotics: Ciprofloxacin + Metronidazole (IV)	44.74	NR	Median 66 [Range 41–86]	NR	NR	NR	NR
Scarpa, 2015, 25960972, Switzerland	Antibiotics: short course IV	47.8	NR	Median 55.5 [Range 24–81]	100/0	none 100	0	NR
Scarpa, 2015, 25960972, Switzerland	Antibiotics: long course IV	51.0	NR	Median 60 [Range 30–86]	100/0	none 100	0	NR
Schug-Pass, 2010, 20140619, Germany	Antibiotic: Ertapenem (4 days)	54	NR	60.6 (12.2)	NR	NR	NR	NR
Schug-Pass, 2010, 20140619, Germany	Antibiotic: Ertapenem (7 days)	55.4	NR	58.5 (11.9)	NR	NR	NR	NR

Table C-2b-4KQ 2b. Risk of bias, randomized comparative studies

Author, Year, PMID, Study Name, Country	Random Sequence Generation	Allocation Concealment	Blinding of Participants	Blinding of Personnel/Care Providers	Incomplete Outcome Data	Selective Outcome Reporting	Were Eligibility/Selection Criteria for the Study Population Prespecified and Clearly Described?	Was the Test/Service/Intervention Clearly Described and Delivered Consistently Across the Study Population?	Were the Outcome Measures Prespecified, Clearly Defined, Valid, Reliable, and Assessed Consistently Across All Study Participants?
AVOD Trial, Sweden	Low	Low	High	High	Low	Low	Yes	Yes	Yes
DIABOLO Trial, Sweden,	Low	Low	High	High	Low	Low	Yes	Yes	Yes
Jaung, 2019, 32240832, STAND, New Zealand and Australia	Low	Low	Low	Low	Low	Low	Yes	Yes	Yes
Kellum, 1992, 1638578, USA	Low	Low	High	High	Low	Low	Yes	Yes	Yes
Kim, 2019, 31267222, S Korea	Low	Low	High	High	Low	Low	Yes	Yes	Yes
Park, 2019, 31290747, S Korea	Low	Low	Low	Low	Low	Low	Yes	Yes	Yes
Ribas, 2010, 20526718, Spain	Low	Low	High	High	Low	Low	Yes	Yes	Yes
Ridgway, 2009, 19016815, Ireland	Low	Unclear	Unclear	High	Low	Low	Yes	Yes	Yes
Schug-Pass, 2010, 20140619, Germany	Unclear	Unclear	High	High	Low	Unclear	Yes	Yes	Yes

: KQ = Key Question, PMID = PubMed Identifier. Ratings are color coded for emphasis only. See Table C-2a-2 for full legend.

Table C-2b-5KQ 2b. Risk of bias, nonrandomized comparative studies

Author, Year, PMID, Study Name, Country	Bias Due to Confounding	Bias in Selection of Participants Into the Study	Random Sequence Generation (Selection Bias)	Allocation Concealment (Selection Bias)	Blinding of Personnel/Care Providers (Performance Bias)	Incomplete Outcome Data (Attrition Bias)	Selective Reporting (Reporting Bias)	Were Eligibility/Selection Criteria for the Study Population Prespecified and Clearly Described?	Was the Test/Service/Intervention Clearly Described and Delivered Consistently Across the Study Population?	Were the Outcome Measures Prespecified, Clearly Defined, Valid, Reliable, and Assessed Consistently Across All Study Participants?
de Korte, 2012, 21689302, Netherlands	Yes	No	N/A	N/A	No	No	Unsure	Yes	No	No
Etzioni, 2010, 20484998, USA	Low	No			No	No	No	Yes	No	Yes
Hjern, 2007, 17190761, Sweden	Yes	No
Scarpa, 2015, 25960972, Switzerland	Yes	No	N/A	N/A	No	No	Yes	Yes	Yes	Yes

: KQ = Key Question, PMID = PubMed Identifier.

Key Question 2c (Interventional Radiology)

Table C-2c-1KQ 2c. Design and arm details

Study, Year, PMID, Country, Funding	Design	Population Description	Arm	Arm Details	Age, Sex	Number of Prior Episodes of Diverticulitis
Lambrichts, 2019, 30811050, Netherlands, NR	NRCS (Retrospective)	CT-diagnosed abscess (Hinchey 1b/II); (Hinchey III/IV), sepsis, or fistula excluded	Interventional radiology	Percutaneous drainage	Mean 63 (SD 13), 62.6% male	None: 61.7% ≥1: 38.3%
Lambrichts, 2019, 30811050, Netherlands, NR	NRCS (Retrospective)		No intervention	No percutaneous drainage	Mean 60 (SD 13), 58.1% male	None: 72.0% ≥1: 28.0%
Mali, 2019, 31320921, Finland, Non-industry	NRCS (Retrospective)	CT-diagnosed abscess ≥4 cm; colon cancer excluded	Interventional radiology	Percutaneous drainage	Median 60 (IQR 50, 69), 61% male	None: 56% ≥1: 44%
Mali, 2019, 31320921, Finland, Non-industry	NRCS (Retrospective)	CT-diagnosed abscess ≥4 cm; colon cancer excluded	Antibiotics: Multiple	Discretionary, undefined antibiotics oral or IV	Median 67, (IQR 55, 78), 39% male	None: 67% ≥1: 33%

: Abbreviations: CT = computed tomography, IQR = interquartile range, IV = intravenous, NR = not reported, NRCS = nonrandomized comparative study, PMID = PubMed identifier, SD = standard deviation.

Table C-2c-2KQ 2c. Risk of bias assessment, NRCSs, assessment of confounding and selection bias

Study, Year, PMID	1.1 Potential for Any Confounding?	1.2 Potential for Time-Varying Confounding?	1.3 Intervention Switches Related to Prognostic Factors?	1.4 Appropriate Analysis Method for Confounding?	1.5 Appropriate cConfounding Variables Used?	1.6 Inappropriate Control of Post-Intervention Variables?	Judgement – Risk of Bias Related to Confounding		2.1 Participant Selection Based on Post-Intervention Variables?	2.2 Post-Intervention Variables Associated with Intervention?	2.3 Post-Intervention Variables Associated with Outcome?	2.4 Start and Follow-Up (Duration) Coincide	2.5 Appropriate Adjustment for Selection Bias	Judgement – Risk of Bias Related to Selection Bias
Lambrichts, 2019, 30811050	Yes	No	N/A	Yes	Yes	No	Low		No	N/A	N/A	Yes	N/A	Low
Mali, 2019, 31320921	Yes	No	N/A	Yes	Yes	No	Low		No	N/A	N/A	Yes	N/A	Low

: KQ = Key Question, NRCS = nonrandomized comparative studies, PMID = PubMed Identifier, Responses to Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) signaling questions 1.1 to 1.6 and 2.1 to 2.5 are in regular font. Each item rated as Yes, PY (probably yes), NI (no information), PN (probably no), No, or N/A (not applicable).
: Judgements about confounding and selection bias are in bold font. (each item rated as Low, Moderate, Serious, or Critical).

Table C-2c-3KQ 2c. Risk of bias assessment, NRCSs, assessment of remaining biases and quality

Study, Year, PMID	Blinding of Participants	Blinding of Personnel/Care Providers	Blinding of Outcome Assessors (Objective Outcomes)	Blinding of Outcome Assessors (Subjective Outcomes)	Incomplete Outcome Data	Selective Outcome Reporting	Other Bias	Eligibility Criteria Prespecified and Clearly Described	Intervention Clearly Described and Consistently Delivered	Outcomes Prespecified, Clearly Defined, Valid, Reliable, and Consistently Assessed
Lambrichts, 2019, 30811050	High	High	Unclear	Unclear	Low	Unclear	Low	Yes	Yes	Yes
Mali, 2019, 31320921	High	High	High	High	Low	Low	Low	Yes	Yes	Yes

: KQ = Key Question, NRCS = nonrandomized comparative study, PMID = PubMed Identifier. Ratings are color coded for emphasis only. See Table C-2a-2 for full legend.

Key Question 3 (Colonoscopy)

Table C-3-1KQ3. Design details

Author, Year, PMID, Country	Study Design	Funder	Years	Inclusion Criteria	Exclusion Criteria
Alcantar, 2019, 31720142, USA	Single group, Retrospective	Not reported (or unclear)	2007, 2017	Patients between the ages of 18 and 49 years with acute diverticulitis	Patients without CT verification of diverticulitis, and patients greater than 50 years old were excluded
Andrade, 2017, 27941344, Portugal	Single group,	Not reported (or unclear)	2008, 2013	patients who underwent a colonoscopy within 1 year after the conservative management of CT-proven acute diverticulitis	emergency surgery, incomplete colonoscopy
Brar, 2013, 24105001, Canada	Single group, Retrospective	Not reported (or unclear)	2007, 2010	patients successfully treated nonoperatively for acute left-sided diverticulitis, and all endoscopy reports before index admission and within 1 year after admission	patients underwent endoscopies more than 1 year after admission, patients underwent complete colonoscopy within the 2 years before admission
Choi, 2014, 24723071, S Korea	NRCS, Retrospective	Not reported (or unclear)	2001, 2013	underwent CT, followed by colonoscopy within a year and diagnosed with acute diverticulitis. For each diverticulitis case, two age- (±5 years) and sex matched control individuals were identified from among healthy individuals who underwent screening colonoscopy.	colorectal cancer, colorectal surgery, underwent colonoscopy 1 year prior to the diagnosis of diverticulitis.
Daniels, 2015, 25472747, Netherlands	NRCS, Retrospective	Non-industry (fully)	2009, 2013	Primary colonoscopy screening population: Only those participants who were randomly invited for primary colonoscopy screening and decided to participate were included in the current study, 50–75 years. Uncomplicated Diverticulitis Population: adult patients, CT proven uncomplicated left sided acute diverticulitis, participating in DIABOLO trial. Patients who had undergone follow up colonoscopy within 6 months were included int his study.	Primary colonoscopy screening population: not willing to participate Uncomplicated Diverticulitis Population: excluded based on DIABOLO trial exclusion criteria
Elmi, 2013, 23701063, USA	Single group, Retrospective	Not reported (or unclear)	2000, 2004	>49 years, acute diverticulitis, evaluation of the colon using colonoscopy	history of colorectal cancer
Horesh, 2016, 27170283, Israel	Single group, Retrospective	Not reported (or unclear)	2008, 2012	patients admitted for a first episode of acute diverticulitis diagnosed based on clinical signs and CT findings and were successfully treated conservatively	patients who underwent colonoscopy during the year prior to presentation
Khoury, 2019, 30632029, Israel	Single group, Retrospective	Not reported (or unclear)	2014, 2018	>16 years, acute diverticulitis, patients who underwent colonoscopy in the period of 6 months following the diagnosis with acute diverticulitis, or patients who performed virtual CT colonography in the case of contraindication to colonoscopy.	Exclusion criteria included patients with undetermined diagnosis of acute diverticulitis; patient who did not complete colonoscopy in the scheduled time; history of inflammatory bowel conditions such as inflammatory bowel disease, collagenous colitis, microscopic colitis, and eosinophilic colitis; patients with oncological diseases; and patients with immunosuppressive therapy.
Lahat, 2007, 17554647, Israel	RCT	Not reported (or unclear)	2004, 2006	All patients underwent abdominal CT, and only those with characteristic findings on CT compatible with the diagnosis of acute diverticulitis	Patients with CT findings of pericolonic air or fluid adjacent to a diverticulum and, obviously, patients with free perforation; patients with a lesion seen on CT scan that was suspicious of colonic cancer; patients who had undergone a colonoscopy within the year prior to the current episode of acute diverticulitis
Lau, 2011, 21904141, Australia	NRCS, Retrospective	Not reported (or unclear)	2003, 2009	diverticulitis confirmed by CT, colonoscopy patients only included who had a follow up colonoscopy within 1 year from the date of CT scan	colonoscopy >1 year from the date of CT scan
Lecleire, 2014, 25083288, France	NRCS, Retrospective	Non-industry (fully)	2005, 2011	Group 1: acute diverticulitis, underwent colonoscopy within 6 months following the acute episode Group 2: sex and age matched with a familial history of colorectal adenoma or neoplasia	patients with haematochezia, recent change in bpwel habits, personal history of colorectal neoplasia, undergone colonoscopy within the 2 years before the episode of diverticulitis
Meireles, 2015, 26378691, Portugal	Single group, Retrospective	Not reported (or unclear)	2004, 2013	patients subjected to endoscopy following the primary episode of diverticulitis	patients with a history of colorectal cancer, diverticular bleeding, or who underwent emergency surgery
O’Donohoe, 2019, 31882879, United Kingdom	Single group, Retrospective	Not reported (or unclear)	2014, 2017	Patients over the age of 18 with CT-diagnosed uncomplicated left-sided diverticulitis (with a modified Hinchey classification of 0 or 1a), admitted 2014–2017, with a follow-up colonoscopy 4–6 weeks after admission	Patients with right sided diverticulitis or complicated diverticulitis
Ramphal, 2018, 29945147, Netherlands	Single group, Retrospective	Not reported (or unclear)	2008, 2013	Hinchey 0 and 1	Hinchey II-IV, previous colorectal cancer, previous episodes of diverticulitis
Sallinen, 2014, 24178863, Finland	NRCS, Retrospective	Not reported (or unclear)	2006, 2010	Clinically and CT diagnosed acute diverticulitis	NR
Schout, 2012, 23171930, Netherlands	Single group, Retrospective	Not reported (or unclear)	2000, 2010	Patients who underwent radiological or surgical abscess drainage only without colon resection	patients who underwent surgical treatment, had a history of colon cancer, had another underlying disease which caused an intra-abdominal abscess, or underwent colonoscopy in the diagnostic process of the episode of diverticulitis
Seoane Urgorri, 2018, 29900742, Spain	Single group, Retrospective	Not reported (or unclear)	2005, 2013	Colonoscopy performed after CT-confirmed diagnosis of acute diverticulitis.	Endoscopy within 2 years prior to episode of acute diverticulitis
Soh, 2018, 29663068, Singapore	NRCS, Retrospective	Not reported (or unclear)	2007, 2011	first episode of CT-proven acute diverticulitis with no complications	NR
Studniarek, 2019, 31908222, USA	Single group, Retrospective	Not reported (or unclear)	2005, 2017	A history of acute diverticulitis as the indication for the colonoscopy, and colonoscopy performed within one year from the initial diagnosis of diverticulitis	NR
Suhardja, 2017, 28035461, Australia	Single group, Retrospective	Not reported (or unclear)	2011, 2013	Patients diagnosed with acute colonic diverticulitis on CT scan and received follow-up colonoscopy	NR

: NR: Not reported

Table C-3-2KQ 3. Arm details

Author, Year, PMID, Country	Arm	Colon Imaging Type	Time Since Bout of Diverticulitis, Mean (SD)
Alcantar, 2019, 31720142, USA	Colonoscopy	Full colonoscopy 100%
Andrade, 2017, 27941344, Portugal	Colonoscopy	Full colonoscopy 100%	16 weeks (11.4 weeks)
Brar, 2013, 24105001, Canada	Colonoscopy	Full colonoscopy 98.4%; Flexible sigmoidoscopy 1.6%;	Median 90 days
Choi, 2014, 24723071, S Korea	Diverticulitis with colonoscopy	Full colonoscopy 100%
Choi, 2014, 24723071, S Korea	Healthy sex matched controls	Full colonoscopy 100%
Daniels, 2015, 25472747, Netherlands	Diverticulitis patients (DIABOLO trial)	Full colonoscopy 100%	Median 55 days
Daniels, 2015, 25472747, Netherlands	Screening individuals (COCOS trial)	Full colonoscopy 100%
Elmi, 2013, 23701063, USA	Colonoscopy	Full colonoscopy 100%	5.3 years; 34.8% in first 6 months
Horesh, 2016, 27170283, Israel	Colonoscopy	Full colonoscopy	Median 3.25 months (range 0.5, 24 months)
Khoury, 2019, 30632029, Israel	Colonoscopy	Full colonoscopy; CT colonography (if there is a contraindication to colonoscopy)	6 months after the diagnosis of acute diverticulitis
Lahat, 2007, 17554647, Israel	Colonoscopy (early; in-hospital)	Full colonoscopy 100%	Median 5.2 days (range 3, 11)
Lahat, 2007, 17554647, Israel	Colonoscopy (late, 6 weeks later)	Full colonoscopy 100%	Median 7.8 days (range 6, 19)
Lau, 2011, 21904141, Australia	Colonoscopy	Full colonoscopy 95%; Flexible sigmoidoscopy 5%; incomplete colonoscopy 6.6%
Lecleire, 2014, 25083288, France	Acute diverticulitis	Full colonoscopy
Lecleire, 2014, 25083288, France	Sex and age matched controls	Full colonoscopy
Meireles, 2015, 26378691, Portugal	Colonoscopy	Full colonoscopy	Median 4.0 months (IQR 1.2, 7.1)
O’Donohoe, 2019, 31882879, United Kingdom	Colonoscopy	Full colonoscopy 100%	Median 37 days (range 27, 68)
Ramphal, 2018, 29945147, Netherlands	Colonoscopy		The patients who underwent colonoscopy between 6 weeks and 3 months after their acute episode of diverticulitis were eligible for analysis.
Sallinen, 2014, 24178863, Finland	Colonoscopy	Full colonoscopy 100%	122 days (180 days)
Schout, 2012, 23171930, Netherlands	Colonoscopy	Full colonoscopy; Flexible sigmoidoscopy; Barium enema; CT colonography	6–10 weeks after discharge
Seoane Urgorri, 2018, 29900742, Spain	Colonoscopy	Full colonoscopy 100%	Median 6–7 weeks
Soh, 2018, 29663068, Singapore	Colonoscopy	Full colonoscopy 98.5%; Barium enema 0.7%; CT colonography 0.7%	Range 6, 8 weeks
Studniarek, 2019, 31908222, USA	Colonoscopy	Full colonoscopy 100%
Suhardja, 2017, 28035461, Australia	Colonoscopy	Full colonoscopy 100%	100% in first year

Table C-3-3KQ3. Baselines

Author, Year, PMID, Study Name, Country	Arm	Male %	Participant Age, Mean (SD)	Age ≥50, %	Complicated/Uncomplicated Diverticulitis %
Alcantar, 2019, 31720142, USA	Colonoscopy	60.3	40.7	NR	22.5/77.5
Andrade, 2017, 27941344, Portugal	Colonoscopy	49.2	Median 55 [IQR 11.1]	NR	NR
Brar, 2013, 24105001, Canada	Colonoscopy	49	55 [range 27, 90]; 63.5% >55	63.5	29.7/70.3
Choi, 2014, 24723071, S Korea	Diverticulitis with colonoscopy	59.7	48.6 (16.5)	NR	14.1/85.9
Choi, 2014, 24723071, S Korea	Healthy sex matched controls	59.9	46.6 (16.6)	NR	8.2/91.8
Daniels, 2015, 25472747, Netherlands	Diverticulitis patients (DIABOLO trial)	47.6	Median 57 [range 49, 65]	NR	NR
Daniels, 2015, 25472747, Netherlands	Screening individuals (COCOS trial)	50.9	Median 60 [range 55, 65]	NR	NR
Elmi, 2013, 23701063, USA	Colonoscopy	42	100% >55	100	NR
Horesh, 2016, 27170283, Israel	Colonoscopy	45.4	62.6 [range 21, 98]; 30.6% >55	30.6	18.5/81.5
Khoury, 2019, 30632029, Israel	Colonoscopy	62	55.73 (13.81) [range 24, 93]	NR	NR
Lahat, 2007, 17554647, Israel	Colonoscopy (early)	31.1	60.5 (11.4)	NR	NR
Lahat, 2007, 17554647, Israel	Colonoscopy (late)	34.1	60.3 (14.7)	NR	NR
Lau, 2011, 21904141, Australia	Colonoscopy	53	15–39y: 7.2%, 40–64y: 55.5%, 65+: 37.3%	NR	NR
Lau, 2011, 21904141, Australia	No Colonoscopy	47.6	15–39y: 8.5%, 40–64y: 54.2%, 65+: 37.3%	NR	NR
Lecleire, 2014, 25083288, France	Acute diverticulitis	41	60.9 (12.6)	NR	10.0/90.0
Lecleire, 2014, 25083288, France	Sex and age matched controls	41	60.7 (13.4)	NR	NR
Meireles, 2015, 26378691, Portugal	Colonoscopy	49.6	64.4 (13.5) [range 23, 103]	NR	28.8/81.2
O’Donohoe, 2019, 31882879, UK	Colonoscopy	28	Median 63 (range 29, 90)	NR	0/100
Ramphal, 2018, 29945147, Netherlands	Colonoscopy	NR	59	NR	NR
Schout, 2012, 23171930, Netherlands	Colonoscopy	NR	NR	NR	NR
Seoane Urgorri, 2018, 29900742, Spain	Colonoscopy	48	59 (15)	NR	27/73
Studniarek, 2019, 31908222, USA	Colonoscopy	51	Median 53 (range 22, 88)	NR	NR
Suhardja, 2017, 28035461, Australia	Colonoscopy	46.1	59.3	NR	27.4/72.6

: NR = Not reported

Table C-3-4KQ 3. Risk of bias

Author, Year, PMID, Country	Adjusted Results in Arm (Subgroup) Differences Reported	Eligibility/Selection Criteria Prespecified	Clear Outcome Definition
Alcantar, 2019, 31720142, USA	No	Yes	Yes
Andrade, 2017, 27941344, Portugal	Yes^*	Yes	Yes
Brar, 2013, 24105001, Canada	Yes^*	Yes	Yes
Choi, 2014, 24723071, S Korea	Yes^*	Yes	Yes
Daniels, 2015, 25472747, Netherlands	Yes ^†	Yes	Yes ^‡
Elmi, 2013, 23701063, USA	No	Yes	Yes
Horesh, 2016, 27170283, Israel	No	Yes	Yes
Khoury, 2019, 30632029, Israel	No	Yes	Yes
Lahat, 2007, 17554647, Israel	No	Yes	Yes
Lau, 2011, 21904141, Australia	No	Yes	Yes ^‡
Lecleire, 2014, 25083288, France	No	Yes	Yes ^‡
Meireles, 2015, 26378691, Portugal	No	Yes	Yes ^‡
O’Donohoe, 2019, 31882879, United Kingdom	No	Yes	Yes
Ramphal, 2018, 29945147, Netherlands	No	Yes	Yes
Sallinen, 2014, 24178863, Finland	No	Yes	Yes ^‡
Schout, 2012, 23171930, Netherlands	No	Yes	Yes
Seoane Urgorri, 2018, 29900742, Spain	No	Yes	Yes
Soh, 2018, 29663068, Singapore	No	Yes	Yes
Studniarek, 2019, 31908222, USA	No	Yes	Yes
Suhardja, 2017, 28035461, Australia	No	Yes	Yes ^‡

: Abbreviations: KQ = Key Question, PMID = PubMed Identifier.
: Ratings are color coded for emphasis only. Each item rated as Yes (lower risk of bias) or No (higher risk of bias).
*: Conducted multivariable analyses for the outcome of advanced colonic neoplasia.
†: Adjusted (e.g., age, family history of CRC) for the outcome of advanced adenomas.
‡: Did not define the outcome of high-grade dysplasia.

Key Questions 4a-b (Prevention, Nonsurgical)

Table C-4ab-1KQ 4ab. Design details and arms

Study, Year, PMID, Country, Funding	Design	Population Description	Arm	Arm Details	Age Sex	Number of Prior Episodes
Festa, 2017, 28387885, Italy, NR	NRCS (Retrospective)	≥18 yr, with ≥1 documented episode of acute diverticulitis in the previous 24 mo that resolved w/o surgery. History of IBD and prior abdominal surgery excluded.	Rifaximin	800 mg/d, 10 d/mo	≤65 years 45.8, >65 years 54.2, 47.2% male	One 86.1% Two or more 13.9%
Festa, 2017, 28387885, Italy, NR	NRCS (Retrospective)		5-ASA	2.4 g/d, 10 d/mo	≤65 years 51.9, >65 years 48.1, 42.3% male	One 90.4% Two or mroe 9.6%
Kruis, 2017, 28543263, SAG-37, Germany, NR	RCT	40–80 yr old w/left-sided uncomplicated acute diverticulitis confirmed by CT or ultrasonography w/≥1 diverticulum in left colon	5-ASA (3.0 g/d)	3.0 g/d	Mean 58.8 SD 9.1 38.2% male	One 55.8% Two 30.9% Three or more 6.7%
Kruis, 2017, 28543263, SAG-37, Germany, NR	RCT		Placebo		Mean 58.3 SD 9.5 44% male	One 54.2% Two 30.4% Three or more 5.4%
Kruis, 2017, 28543263, SAG-51, USA/Germany, NR	RCT	30–80 yr old w/left-sided uncomplicated acute diverticulitis confirmed by CT or ultrasonography w/≥1 diverticulum in left colon	5-ASA (1.5 g/d)	1.5 g/d	Mean 55.6 SD 10.4 30.9% male	One 53.7% Two 29.3% Three or more 5.7%
			5-ASA (3.0 g/d)	3.0 g/d	Mean 55.2 SD 11.3 43.3% male	One 53.3% Two 26.7% Three or more 7.7%
			Placebo		Mean 55.4 SD 10.3 44.1% male	One 46.8% Two 36.9% Three or more 9.0%
Kvasnovsky, 2017, 28528364, International, Industry	RCT	Abdominal symptoms ≥3 mo w/uncomplicated diverticulitis	Probiotics Symprove	1 mL/kg/d	Median 60 (IQR 52, 72) 55.6% male	NR
Kvasnovsky, 2017, 28528364, International, Industry	RCT	Abdominal symptoms ≥3 mo w/uncomplicated diverticulitis	Placebo		Median 63.5 (IQR 54, 72.5) 44.4% male	NR
Lanas, 2013, 23092785, Spain, Industry	RCT	≥18 years w/≥1 acute diverticulitis in remission at enrollment. Acute ep at recruitment excluded.	Rifaximin	Rifaximin (800 mg/d) + fiber 3.5 g/d	53.6 (12.0) 66.2% male	At least one: 100%
Lanas, 2013, 23092785, Spain, Industry	RCT		Placebo	Placebo + fiber 3.5 g/d	54.7 (13.2) 62.5% male	At least one: 100%
Mizuki, 2019, 31043657, Japan, NR	RCT	Diagnosed with CDB or uncomplicated ACD and aged between 20–85 years	Burdock tea	NR	Mean 48 (Range 24, 82) 55.3% male	At least one: 18%
Mizuki, 2019, 31043657, Japan, NR	RCT		No intervention (non-placebo)		Mean 53 (Range 27, 79) 47.7% male	At least one 8%
Parente, 2013, 23754545, Italy, Industry	RCT	18–85 yo w/diverticular disease of left colon and/or ep. Of uncomplicated diverticulitis. Complicated diverticulitis excluded.	5-ASA	800 mg 2/d for 10 d/mo	Mean 61.9 (Range 35, 80) SD 10 44.4% male	None 100%
Parente, 2013, 23754545, Italy, Industry	RCT		Placebo		Mean 61.1 (Range 23, 84) SD 12.2 53.2% male	None 100%
Raskin, 2014, 25038431, PREVENT-1, International, Industry	RCT	1 documented episodes of acute diverticulitis in the previous 24 mo that resolved w/o colonic resection, and w/o signs/symptoms of diverticulitis within 6 wks of enrollment. Confirmation of diverticulosis via endoscopic evaluation of the sigmoid colon w/at ≥3 diverticula noted	5-ASA (1.2 g/d)	1.2 g/d	55.3 (11.39) 52.8% male	None 0.3% One 58.1% Two 25.4% Four or five 5.5% Six to ten 2.1
			5-ASA (2.4 g/d)	2.4 g/d
			5-ASA (4.8 g/d)	4.8 g/d
			Placebo	Daily
Raskin, 2014, 25038431, PREVENT-2, International, Industry	RCT	1 documented episodes of acute diverticulitis in the previous 24 mo that resolved w/o colonic resection, and w/o signs/symptoms of diverticulitis within 6 wks of enrollment. Confirmation of diverticulosis via endoscopic evaluation of the sigmoid colon w/at ≥3 diverticula noted	5-ASA (1.2 g/d)	1.2 g/d	Mean 56.1 SD 11.04 46.4% male	None 0.5% One 59.7% Two 22.7% Four to Five 5.8% Six to Ten 1.9%
			5-ASA (2.4 g/d)	2.4 g/d
			5-ASA (4.8g/d)	4.8 g/d
			Placebo	Daily
Silva Sanchez, 2014, International, NR	Single-group (Unclear)	NR (abstract)	5-ASA (4.8 g/d)	4.8 g/d	NR	NR
Stollman, 2013, 23426454, DIVA, USA, Industry	RCT	35–85 yr old, acute diverticulitis (first, second, or third attack) confirmed by CT scan, a GSS score ≥12 at baseline, an abdominal pain assessment score >2. Patients initially enrolled with acute diverticulitis, but randomization occurred after resolution, up to 14 days later	5-ASA + Probiotic (Bifidobacterium infantis 35624)	5-ASA 2.4 g/day + Probiotic: 1/day, 12 wk	Mean 59.1 SD 10.1 47.2% male	None 52.8% One 22.2% Two 25.0%
			5-ASA	2.4 g/day, 12 wk	Mean 57.7 SD 12.8 42.5% male	None 45.0% One 35.0% Two 20.0%
			Placebo	Placebos for 5-ASA and for probiotic, 12 wk	Mean 56.1 SD 11.1 53.7% male	None 51.2% One 34.1% Two 14.6%
Tursi, 2002, 12236485, Italy, NR	RCT	Diverticulitis w/≥2 attacks of acute diverticulitis in previous yr	5-ASA + Rifaximin	5-ASA (1.6 g/d) + rifaximin (800 mg/d), 7 d/mo^†	Mean 66.5 59% male	Two: 82.6% Three or more: 17.4%
Tursi, 2002, 12236485, Italy, NR	RCT		Rifaximin	Rifaximin (800 mg/d), 7 d/mo	Mean 62.1 61.4% male	Two: 84.4% Three or more: 15.6%
Tursi, 2007, 17390144, Italy, NR	RCT	Uncomplicated acute diverticulitis	5-ASA + Probiotic	Balsalazide (2.25 mg/d), 10 d/mo + VSL#3 (1 bag/d), 15 d/mo^*	Mean 60.1 (Range 47, 75)	Two: 83.5% Three or more: 16.5%
Tursi, 2007, 17390144, Italy, NR	RCT	Uncomplicated acute diverticulitis	Probiotics	VSL#3 (1 bag/d), 15 d/mo^*	Mean 60.1 (Range 47, 75)	Two: 83.5% Three or more: 16.5%

: d = day, wk = weeks, mo = month, NR = not reported, PMID = PubMed identifier, y = years, g/d = grams/per day,
*: During the first 10 days of treatment, patients in both groups also took rifaximin 800 g/d.,
†: During the first 7 days of tresatment, 5-ASA 2.4 g/d + rifaximin 800 mg/d vs. rifaximin 800 mg/d.

Table C-4ab-2KQ 4ab. Risk of bias, RCTs

Author, Year, PMID, Study Name, Country	Random Sequence Generation (Selection Bias)	Allocation Concealment (Selection Bias)	Blinding of Participants, Personel, Care Providers, Outcome Assessor	Incomplete Outcome Data (Attrition Bias)	Selective Reporting (Reporting Bias)	Other Bias
Kruis, 2017, 28543263, SAG-37, Germany	Low	Low	Low	Low	Low	Low
Kruis, 2017, 28543263, SAG-57, USA/Germany	Low	Low	Low	Low	Low	Low
Kvasnovsky, 2017, 28528364, International	High	High	High	Low	High	Low
Lanas, 2013, 23092785, Spain	Low	Low	High	Low	Low	High
Mizuki, 2019, 31043657, Japan	Low	Low	Low	Low	Low	Low
Parente, 2013, 23754545, Italy	Unclear	Unclear	Low	Low	High	Low
Raskin, 2014, 25038431, PREVENT1, International	Low	Low	Low	Low	Low	Low
Raskin, 2014, 25038431, PREVENT2, International	Low	Low	Low	Low	Low	Low
Stollman, 2013, 23426454, DIVA, USA	Low	Low	Low	High	Low	Low
Tursi, 2002, 12236485, Italy	High	High	High	Low	Low	Low
Tursi, 2007, 17390144, Italy	Unclear	High	High	Low	Low	Low

: KQ = Key Question, PMID = PubMed Identifier. Ratings are color coded for emphasis only. See Table C-2a-2 for full legend.

Table C-4ab-3KQ 4ab. Risk of bias, NRCSs

Author, year, PMID, Study Name, Country	Random Sequence Generation (Selection Bias)	Allocation Concealment (Selection Bias)	Blinding of Participants, Personel, Care Providers, Outcome Assessor	Incomplete Outcome Data (Attrition Bias)	Selective Reporting (Reporting Bias)	Were Eligibility/Selection Criteria for the Study Population Prespecified And Clearly Described?	Was the Test/Service/Intervention Clearly Described and Delivered Consistently Across the Study Population?	Were the Outcome Measures Prespecified, Clearly Defined, Valid, Reliable, And Assessed Consistently Across All Study Participants?	No Bias Due to Confounding	No Bias in Selection of Participants Into The Study
Festa, 2017, 28387885, Italy	N/A	N/A	Low	High	High	Yes	Yes	Yes	No	Yes

: KQ = Key Question, PMID = PubMed Identifier. Ratings are color coded for emphasis only. See Table C-2a-2 for full legend.

Key Question 4c (Elective Surgery)

Table C-4c-1KQ 4c. Design details

Author, year, PMID, Study Name, Country	Study Design	Funder	Study Dates	Inclusion Criteria	Exclusion Criteria	How Was Diverticulitis Diagnosed?
Aquina, 2019, 30335195, USA	NRCS (Retrospective)	Not reported (or unclear)	2002, 2010	at least 18 years, acute diverticular abscess	laparotomy, laparoscopy, colectomy or stoma creation within 2 days of admission; concurrent diagnosis of colorectal cancer, cirrhosis, or ascites	NR
Bhakta, 2016, 26275534, Albany Medical Center 2001–13, USA	Single group (Prospective)	Non-industry (fully)	2001, 2013	diverticulitis requiring elective surgery	none	diverticulitis was defined as either a physician-documented or self-reported episode of left lower quadrant abdominal pain and tenderness, with or without fever and leukocytosis.
Boostrom, 2012, 22696233, Mayo Clinic, Rochester, USA	Single group (Retrospective)	Not reported (or unclear)	2005, 2009	patients who underwent sigmoid resection for a diagnosis of diverticulitis	emergent resection	Acute resolving uncomplicated diverticulitis is defined as discrete episodes of left lower quadrant abdominal pain, fever, leukocytosis, and evidence of inflammation on imaging that resolve with conservative management. Chronic/ smoldering uncomplicated diverticulitis is defined as symptoms of left lower quadrant abdominal pain and evidence of inflammation (elevated white blood cell count, fever, CT evidence of inflammation) that does not improve with the traditional antibiotic regimen, or re-exacerbation with cessation of antibiotics, for at least 3 months’ duration. Atypical uncomplicated diverticulitis is defined as symptoms of left lower quadrant pain and possible alterations in bowel habits for a period of at least 3 months; however, other clinical and radiographic evidence of diverticulitis is not present.
Bordeianou, 2019, 29916880, PREVENTT, USA	Single group (Prospective)	Not reported (or unclear)	2010, 2016	underwent surgery for diverticulitis	< 18 years of age, underwent a colectomy with a diagnosis of colon or rectal cancer or IBD.	NR
Ilyas, 2017, 27422847, Nationwide Inpatient Sample (2004–2001), USA	Single group (Retrospective)	Non-industry (fully)	2004, 2011	Procedure codes were used from ICD-9 to identify patients who underwent elective sigmoid resection.	Patients with acute diverticulitis, perforated diverticulitis, preoperative weight loss and metastatic disease were excluded.	Patients with an ICD-9 diagnosis code of diverticulitis were identified. (ICD-9 codes 562.11 and 562.13)
Lidor, 2010, 20878256, USA	Single group (Retrospective)	Non-industry (fully)	2004, 2007	≥65 years old; primary admission diagnosis of diverticulitis by ICD-9	concurrent diagnosis of colorectal cancer	NR
Masoomi, 2011, 21732208, Nationwide Inpatient Sample (2002–2007), USA	Single group (Retrospective)	Non-industry (fully)	2002, 2007	Hospitalizations resulting from elective colon resection were identified with ICD procedure code and then divided into open surgery and laparoscopy groups.	Urgent colon resection	All discharges with International Classification of Disease (ICD) procedure codes [sigmoidectomy (45.76) or anterior resection (48.62, 48.63)] with a primary diagnosis of diverticulitis (codes 562.11 and 562.13) were selected from 2002 to 2007; those patients with the admission code for an elective operation were identified and utilized in the study.
Moghadamyeghaneh, 2015, 26116319, ACS-NSQIP 2012–13, USA	Single group (Retrospective)	Not reported (or unclear)	2012, 2013	Diverticulitis who underwent colon re-sections using procedural and diagnosis codes as specified by the ICD 9th Revision.	Underwent colon surgery without colon resection and patients < 18 yo	Colonic diverticulitis based on ICD 9 code 562.11. Colon resection based on Current Procedural Terminology codes: 44140 to 44147, 44204 to 44208, 45110, and 45113.
Novitsky, 2009, 18639223, Nationwide Inpatient Sample (2001–2002), USA	Single group (Retrospective)	Non-industry (fully)	2001, 2002	Patients with ICD codes who underwent elective surgery for diverticulitis.	Patients ?18 years and those with a diagnosis of colon cancer were excluded from the analysis.	Patients with ICD codes for diverticulitis diagnostic codes were identified. Patients with colectomy procedure codes were then cross referenced to obtain patients who underwent elective surgery for diverticulitis.
Papageorge, 2016, 27120447, ACS-NSQIP 2005–13, USA	Single group (Retrospective)	Not reported (or unclear)	2005, 2013	Primary procedure CPT code or one of the secondary CPT codes (from the “other procedure” variables) was for partial colectomy or colostomy.	Cases performed emergently, patients of ASA class 5 or unknown ASA class, cases performed by a surgical specialist in a field other than general surgery, presence of preoperative SIRS, sepsis or septic shock, and preoperative ventilator dependence.	Acute diverticulitis w/o hemorrhage or diverticulosis w/o hemorrhage by ICD-9 codes 562.11 and 562.1.
Pessaux, 2004, 14639493, French Association for Surgical Research, France	Single group (Retrospective)	Not reported (or unclear)	1985, 1998	elective sigmoid resection by laparotomy at least 1.5 month after an acute episode of diverticulitis, followed by primary anastomosis with or without protective stoma.	prior colon resection, emergency resection, surgery without resection, resection without primary anastomosis, and patients undergoing laparoscopic resection	NR
Russ, 2010, 20193685, ACS-NSQIP 2005–08, USA	Single group (Retrospective)	Not reported (or unclear)	2005, 2008	Emergency and nonemergency cardiac and noncardiac surgery. Diverticular disease were identified by ICD-9 codes and then categorized based on procedure type using CPT codes.	Defined by the NSQIP to have undergone emergency surgery. Definition includes patients who had surgery within 12 hours of admission.	Diverticular disease were identified by ICD-9 codes
Silva-Velazco, 2016, 26541732, USA	Single group (Prospective)	Non-industry (fully)	1992, 2013	elective, restorative procedures for sigmoid diverticulitis performed using a minimally invasive approach	disease presentations requiring urgent surgery	diverticulitis was radiologically confirmed in 1032 patients (97.5 %), while outside preoperative imaging was not available in our institutional records in the remaining 27 patients
Simianu, 2015, 25773308, Surgical Care and Outcomes Assessment Program (SCOAP), USA	Single group (Prospective)	Non-industry (fully)	2010, 2013	underwent laparoscopic colon resection for diverticulitis	none	NR
Tsilimparis, 2010, 20812161, Fast-track Kolon II, Germany	Single group (Prospective)	Not reported (or unclear)	2005, 2008	all patients with elective laparoscopic sigma resection for diverticulitis	emergency surgery within 24 hours of admission, ileus, perforation, <18 years old, pregnant	NR
Valizadeh, 2018, 30747633, ACS-NSQIP 2012–13, USA	Single group (Retrospective)	Not reported (or unclear)	2012, 2013	Chronic diverticular disease or acute diverticulitis	NR	NR
van de Wall, 2017, 28404008, DIRECT trial, Netherlands	RCT	Non-industry (fully)	2010, 2014	patients aged 18–75 years who presented to trial centres with either ongoing abdominal complaints or frequently recurring left-sided diverticulitis after a confirmed (ie, seen with CT scan, ultrasonography, or endoscopy) episode of diverticulitis.	1) previous elective or emergency surgery for acute sigmoid diverticulitis, OR 2) an absolute operation indication, OR 3) suspicion of a colorectal malignancy, OR 4) patients classified with a preoperative or postoperative risk of greater than III on the American Society of Anesthesiologists (ASA) classification	The Hinchey classification was used to classify the primary episode of diverticulitis and was based on findings of either CT scan or ultrasonography
Varma, 2019, 30527478, California State Inpatient Database 2005–13, USA	Single group (Retrospective)	Non-industry (fully)	2005, 2011	experienced an initial episode of uncomplicated diverticulitis (562.10, 562.11), were medically managed during their initial presentation, and underwent a bowel resection afterward	diagnoses for malignancy (153, 196, 197, 198), undergoing spinal cord (3.9), thorax (33.2, 34.9), ventral hernia (53.4, 53.5), and salpingo-oophorectomies (65.4, 65.6) procedures; or missing clinical factors	NR
You, 2018, 29683483, USA	RCT	Industry (fully or in part)	2011, 2016	≥18 with a first episode of acute diverticulitis of the sigmoid colon complicated by extraluminal air with or without abscess, first treated with successful non-operative management and colonoscopy negative for malignancy.	history of previous diverticulitis of the sigmoid colon; history of diverticulitis of the sigmoid colon, colonic cancer at colonoscopy, immunosuppression, acute diverticulitis of the sigmoid colon complicated by peritonitis and/or distant free air, pregnancy, or inability to sign informed consent.	Not explicitly described

Table C-4c-2KQ 4c. Arm details

Author, Year, PMID, Study Name, Country	Arm	Surgery Type	Time Frame of Elective Surgery in Relation to Last Acute Diverticulitis
Aquina, 2019, 30335195, USA	Elective surgery	Colectomy	< 6 months
Aquina, 2019, 30335195, USA	No intervention (Nonoperative management)	N/A	NR
Bhakta, 2016, 26275534, Albany Medical Center 2001–13, USA	Elective surgery	Laparoscopic	NR
Boostrom, 2012, 22696233, Mayo Clinic, Rochester, USA	Elective surgery (Arm 1: Acute resolving uncomplicated diverticulitis)	Sigmoidectomy (any 24%, laparoscopic 25%, hand-assisted 50%, robot-assisted 0.3%)	NR
	Elective surgery (Arm2: Chronic/smoldering uncomplicated diverticulitis)	Sigmoidectomy (any 12%, laparoscopic 30%, hand-assisted 56%, robot-assisted 2%)	NR
	Elective surgery (Arm3: Atypical uncomplicated diverticulitis )	Sigmoidectomy (any 15%, laparoscopic 30%, hand-assisted 55%)	NR
Bordeianou, 2019, 29916880, PREVENTT, USA	Elective surgery	Any	NR
Ilyas, 2017, 27422847, Nationwide Inpatient Sample (2004–2001), USA	Elective surgery	Sigmoidectomy	NR
Lidor, 2010, 20878256, USA	Elective surgery	Left colectomyLeft colectomy with ileostomy	NR
Masoomi, 2011, 21732208, Nationwide Inpatient Sample (2002–2007), USA	Elective surgery (Open surgery)	Open	NR
	Elective surgery (Laparoscopy)	Laparoscopic	NR
Moghadamyeghaneh, 2015, 26116319, ACS-NSQIP 2012–13, USA	Elective surgery (2012–2013)	Open 28%Laparoscopic (72%)	NR
Novitsky, 2009, 18639223, Nationwide Inpatient Sample (2001–2002), USA	Elective surgery	Left colectomyLeft colectomy with ostomyLeft colectomy with ileostomy1	NR
Papageorge, 2016, 27120447, ACS-NSQIP 2005–13, USA	Elective surgery (2005/06)	Laparoscopic approach and ostomy creation, as defined by the CPT code.	NR
	Elective surgery (2007)		NR
	Elective surgery (2008)		NR
	Elective surgery (2009)		NR
	Elective surgery (2010)		NR
	Elective surgery (2011)		NR
	Elective surgery (2012)		NR
	Elective surgery (2013)		NR
Pessaux, 2004, 14639493, French Association for Surgical Research, France	Elective surgery (elective laparotomy for colon or rectal resection for diverticulitis)	Sigmoidectomy	> 1.5 months
Russ, 2010, 20193685, ACS-NSQIP 2005–08, USA	Elective surgery (Open procedure)	Open	NR
Russ, 2010, 20193685, ACS-NSQIP 2005–08, USA	Elective surgery (Laparoscopic procedure)	Laparoscopic	NR
Silva-Velazco, 2016, 26541732, USA	Elective surgery	Laparoscopic	range 6, 8 weeks
Simianu, 2015, 25773308, Surgical Care and Outcomes Assessment Program (SCOAP), USA	Elective surgery	Laparoscopic	NR
Tsilimparis, 2010, 20812161, Fast-track Kolon II, Germany	Elective surgery	Laparoscopic	>1 day
Valizadeh, 2018, 30747633, ACS-NSQIP 2012–13, USA	Elective surgery	NR	NR
van de Wall, 2017, 28404008, DIRECT trial, Netherlands	Elective surgery (Laparoscopic surgery)	Sigmoidectomy, laparoscopic	NR
van de Wall, 2017, 28404008, DIRECT trial, Netherlands	No intervention (Conservative management treatment: current daily practice)	n/a	NR
Varma, 2019, 30527478, California State Inpatient Database 2005–13, USA	Elective surgery	Any	median 3.8 months (IQR 2.3, 8.1 months; range 30 days, 2 years)
You, 2018, 29683483, USA	No intervention (Observation)	none	NR
You, 2018, 29683483, USA	Elective surgery (underwent elective resection of the sigmoid colon with colorectal anastomosis via a minimally invasive access.)	Laparoscopic	NR

Table C-4c-3KQ 4c. Baselines

Author, year, PMID, Study Name, Country	Arm	Male %	Race/Ethnicity	Age, Mean (SD) or %	Participants With Un/Complicated Diverticulitis, %	Specific Complications of Diverticulitis %	Number of Prior Episodes of Diverticulitis, %	Time Since Last Episode of Diverticulitis, Mean (SD)
Aquina, 2019, 30335195, USA	Elective surgery	51.8	White 87.1%, Black 4.8%, Other 5.6%, Unknown 2.5%	Median 56 (IQR 47, 66); <=50 years 35.3, 51–65 years 39.2, >65 years 25.5	.		at least one 16.3
Aquina, 2019, 30335195, USA	No intervention (non-placebo) (Nonoperative management)	46.3	White 74.2%, Black 11.9%, Other 11.1%, Unknown 2.7%	Median 58 (IQR 47, 72); <=50 years 33.8, 51–65 years 30.7, >65 years 35.6	.		at least one 10.0
Bhakta, 2016, 26275534, Albany Medical Center 2001–13, USA	Elective surgery	47		55.7	75.9/24.1	abscess 8.3, perforated diverticulitis 0.7, stricture 3.6, immunocompromised 0.5	Mean 3.1 [range 1, 12]
Boostrom, 2012, 22696233, Mayo Clinic, Rochester, USA	Elective surgery (Arm 1: Acute resolving uncomplicated diverticulitis)	45		Median 63			Median 3 [range 1, 15]
	Elective surgery (Arm2: Chronic/smoldering uncomplicated diverticulitis)	38		Median 66
	Elective surgery (Arm3: Atypical uncomplicated diverticulitis )	37		Median 64
Bordeianou, 2019, 29916880, PREVENTT, USA	Total	43.6	White 93.4%, Hispanic/Latino 3.2%	59.9 (12.7)			at least one 50
Ilyas, 2017, 27422847, Nationwide Inpatient Sample (2004–2001), USA	Elective surgery	45.7	White 82.3%	65.7 (13.1)
Lidor, 2010, 20878256, USA	Elective surgery	28.9	White 95.35%, Black 3.1%, Other 1.55%	73.9 (5.9); 65–69 years 28.8, 70–74 years 29.7, 75–79 years 23.5, 80–85 years 12.6, 85+ years 5.5	.
Masoomi, 2011, 21732208, Nationwide Inpatient Sample (2002–2007), USA	Elective surgery (Open surgery)	47.1	White 89%, Black 3.4%, Hispanic/Latino 4.9%, Asian 0.3%	57
	Elective surgery (Laparoscopy)	47.4	White 84.9%, Black 3.7%, Hispanic/Latino 8.8%, Asian 0.1%	55
Moghadamyeghaneh, 2015, 26116319, ACS-NSQIP 2012–13, USA	Elective surgery (2012–2013)	45.9	White 91.8%, Black 6.4%, Asian 1%, Other 0.7%	58 (12)
Novitsky, 2009, 18639223, Nationwide Inpatient Sample (2001–2002), USA	Elective surgery	41.8		67.1 (13.8)
Papageorge, 2016, 27120447, ACS-NSQIP 2005–13, USA	Elective surgery (2005/06)	48		<50 years 29.7, 65+ years 29.6
	Elective surgery (2007)	47.6		<50 years 28.5, 65+ years 28.8
	Elective surgery (2008)	46.8		<50 years 27.9, 65+ years 29
	Elective surgery (2009)	45		<50 years 27.3, 65+ years 30
	Elective surgery (2010)	44.6		<50 years 25.9, 65+ years 29.7
	Elective surgery (2011)	45.2		<50 years 25.9, 65+ years 29.7
	Elective surgery (2012)	46.2		<50 years 24.5, 65+ years 31.8
	Elective surgery (2013)	44.5		<50 years 24.2, 65+ years 32.3
Pessaux, 2004, 14639493, French Association for Surgical Research, France	Elective surgery (elective laparotomy for colon or rectal resection for diverticulitis)	46.6		<58 years 37.5, 59–75 years 45.8, >76 years 16.7				[range >1.5 months]
Russ, 2010, 20193685, ACS-NSQIP 2005–08, USA	Elective surgery (Open procedure)	46.9	White 79.2%, Black 6.9%, Other 14%	59.2
Russ, 2010, 20193685, ACS-NSQIP 2005–08, USA	Elective surgery (Laparoscopic procedure)	49.1	White 83.5%, Black 3.4%, Other 13.2%	55.6
Silva-Velazco, 2016, 26541732, USA	Elective surgery	52		55 (12)		Preoperative percutaneous abscess drainage 6	.	[range 6, 8 weeks]
Simianu, 2015, 25773308, Surgical Care and Outcomes Assessment Program (SCOAP), USA	Elective surgery	47	White 87.2%	57.8 (12.7)		Colovesicular fistula 8.7, current GI bleed 2.3, stricture 4.4	none 13.9, one 15.2, two 14.5, at least three 52.5
Tsilimparis, 2010, 20812161, Fast-track Kolon II, Germany	Elective surgery	42		63 [Range 23, 91]; <60 years 42, 60–69 years 33, >69 years 25	100/0
Valizadeh, 2018, 30747633, ACS-NSQIP 2012–13, USA	Elective surgery	nr		>65 years 31.5
van de Wall, 2017, 28404008, DIRECT trial, Netherlands	Elective surgery (Laparoscopic surgery)	28		Median 54.1 (IQR 44.6–62.1)			Mean 3.1 (SD 1.0)
van de Wall, 2017, 28404008, DIRECT trial, Netherlands	No intervention (non-placebo) (Conservative management treatment: current daily practice)	43		Median 56.5 (IQR 48.3–63.2)			Mean 4.1 (SD 2.0)
Varma, 2019, 30527478, California State Inpatient Database 2005–13, USA	Elective surgery	48.4	White 69.0%, Black 3.5%, Hispanic/Latino 18.9%, Other/missing 8.6%	55.3 (13.8)	89/11		one 70.8, two 21.8, at least three 7.4	[range 30d, 2y]
You, 2018, 29683483, USA	Placebo (Observation)	63		55.2 (13.1)		Abscess 42, extraluminal air 100	none 100
You, 2018, 29683483, USA	Elective surgery	54		53.3 (13.5)		Abscess 58, extraluminal air 100	none 100

Table C-4c-4KQ 4c. Risk of bias, RCTs and NRCS

Author, Year, PMID, Study Name, Country	Random Sequence Generation (Selection Bias)	Allocation Concealment (Selection Bias)	Blinding OF Participants, Personel, Care Providers, Outcome Assessor	Incomplete Outcome Data (Attrition Bias)	Selective Reporting (Reporting Bias)	Were Eligibility/Selection Criteria for the Study Population Prespecified and Clearly Described?	Was the Test/Service/Intervention Clearly Described and Delivered Consistently Across the Study Population?	Were the Outcome Measures Prespecified, Clearly Defined, Valid, Reliable, and Assessed Consistently Across All Study Participants?	Bias Due to Confounding	Bias in Selection of Participants Into the Study
Aquina, 2019, 30335195, USA	High	High	High	Low	Low	Yes	Yes	Yes	Low	Low
van de Wall, 2017, 28404008, DIRECT trial, Netherlands	Low	Low	High	Low	Low	Yes	Yes	Yes	Low	Low
You, 2018, 29683483, USA	Low	Unclear	High	Low	Low	Yes	No	Yes	Low	Low

: KQ = Key Question, PMID = PubMed Identifier. Ratings are color coded for emphasis only. See Table C-2a-2 for full legend.

Table C-4c-5KQ 4c. Risk of bias, single-group studies

Author, year, PMID, Study Name, Country	Incomplete Outcome Data (Attrition Bias)	Selective Reporting (Reporting Bias)	Were Eligibility/Selection Criteria for the Study Population Prespecified and Clearly Described?	Was the Test/Service/Intervention Clearly Described and Delivered Consistently Across the Study Population?	Were the Outcome Measures Prespecified, Clearly Defined, Valid, Reliable, and Assessed Consistently Across All Study Participants?
Bhakta, 2016, 26275534, Albany Medical Center 2001–13, USA	Low	Low	Yes	Yes	Yes
Boostrom, 2012, 22696233, Mayo Clinic, Rochester, USA	Low	Low	Yes	Yes	Yes
Bordeianou, 2019, 29916880, PREVENTT, USA	Low	Low	Yes	No	Yes
Ilyas, 2017, 27422847, Nationwide Inpatient Sample (2004–2001), USA	Low	Low	Yes	No	Yes
Lidor, 2010, 20878256, USA	Low	High	Yes	Yes	Yes
Masoomi, 2011, 21732208, Nationwide Inpatient Sample (2002–2007), USA	Low	Low	Yes	Yes	Yes
Moghadamyeghaneh, 2015, 26116319, ACS-NSQIP 2012–13, USA	Low	Low	Yes	Yes	Yes
Novitsky, 2009, 18639223, Nationwide Inpatient Sample (2001–2002), USA	Low	Low	Yes	Yes	Yes
Papageorge, 2016, 27120447, ACS-NSQIP 2005–13, USA	Low	Low	Yes	Yes	Yes
Pessaux, 2004, 14639493, French Association for Surgical Research, France	Low	Low	Yes	Yes	Yes
Russ, 2010, 20193685, ACS-NSQIP 2005–08, USA	Low	Low	Yes	Yes	Yes
Silva-Velazco, 2016, 26541732, USA	Low	Unclear	Yes	Yes	Yes
Simianu, 2015, 25773308, Surgical Care and Outcomes Assessment Program (SCOAP), USA	Low	Low	Yes	Yes	Yes
Tsilimparis, 2010, 20812161, Fast-track Kolon II, Germany	Low	Low	Yes	Yes	Yes
Valizadeh, 2018, 30747633, ACS-NSQIP 2012–13, USA	Low	Low	Yes	Yes	Yes
Varma, 2019, 30527478, California State Inpatient Database 2005–13, USA	Low	Low	Yes	Yes	Yes

: KQ = Key Question, PMID = PubMed Identifier. Ratings are color coded for emphasis only: Low/Yes, High/No, or Unclear.

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Balk EM, Adam GP, Cao W, et al. Management of Colonic Diverticulitis [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Oct. (Comparative Effectiveness Review, No. 233.) Appendix C, Search Results; Study Design, Arm Details, Baselines, and Quality.
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Management of Colonic Diverticulitis [Internet].

Appendix CSearch Results; Study Design, Arm Details, Baselines, and Quality

Search Results

Figure C-1Literature flow diagram

Included Studies

Key Question 1 (CT Imaging)

Key Question 2a (Outpatient)

Key Question 2b (Antibiotics)

Key Question 2c (Interventional Radiology)

Key Question 3 (Colonoscopy)

Key Questions 4a-b (Prevention, Nonsurgical)

Key Question 4c (Elective Surgery)

Study Design Details and Arms, Risk of Bias

Key Question 1 (CT Imaging)

Table C-1-1KQ 1. Description

Table C-1-2KQ 1. Population and diagnostic descriptives

Table C-1-3KQ 1. Quality

Key Question 2a (Outpatient)

Table C-2a-1KQ 2a. Design details and arms

Table C-2a-2KQ 2a. Risk of bias assessment for primary studies – randomized controlled trials (RCTs)

Table C-2a-3KQ 2a. Risk of bias assessment for primary studies – nonrandomized comparative studies (NRCSs) – assessment of confounding and selection bias

Key Question 2b (Antibiotics)

Table C-2b-1KQ 2b. Design details

Table C-2b-2KQ 2b. Arm details

Table C-2b-3KQ 2b. Baselines

Table C-2b-4KQ 2b. Risk of bias, randomized comparative studies

Table C-2b-5KQ 2b. Risk of bias, nonrandomized comparative studies

Key Question 2c (Interventional Radiology)

Table C-2c-1KQ 2c. Design and arm details

Table C-2c-2KQ 2c. Risk of bias assessment, NRCSs, assessment of confounding and selection bias

Table C-2c-3KQ 2c. Risk of bias assessment, NRCSs, assessment of remaining biases and quality

Key Question 3 (Colonoscopy)

Table C-3-1KQ3. Design details

Table C-3-2KQ 3. Arm details

Table C-3-3KQ3. Baselines

Table C-3-4KQ 3. Risk of bias

Key Questions 4a-b (Prevention, Nonsurgical)

Table C-4ab-1KQ 4ab. Design details and arms

Table C-4ab-2KQ 4ab. Risk of bias, RCTs

Table C-4ab-3KQ 4ab. Risk of bias, NRCSs

Key Question 4c (Elective Surgery)

Table C-4c-1KQ 4c. Design details

Table C-4c-2KQ 4c. Arm details

Table C-4c-3KQ 4c. Baselines

Table C-4c-4KQ 4c. Risk of bias, RCTs and NRCS

Table C-4c-5KQ 4c. Risk of bias, single-group studies

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