Utility of Colonoscopy After Acute Colonic Diverticulitis

Acute diverticulitis (AD) is a common gastrointestinal condition that has seen a significant rise in incidence and prevalence, largely due to the aging population and the increasing prevalence of obesity. Historically, routine colonoscopy was recommended after every episode of AD, but recent studies and meta-analyses have questioned this practice. Evidence now supports a more selective approach, suggesting that colonoscopy should only be performed in patients with complicated AD, persistent alarm symptoms (abdominal pain, weight loss, altered bowel habits, blood in stool, or iron-deficiency anemia), or imaging findings suggestive of neoplasia. For uncomplicated AD without alarm symptoms, routine colonoscopy is not justified, as it may lead to unnecessary complications and overuse of healthcare resources. Current guidelines reflect this shift, recommending individualized decision-making based on the patient's clinical history and risk factors. Emerging non-invasive diagnostic tools, such as fecal immunochemical tests (FIT) and artificial intelligence (AI)-based models, hold promise for improving risk stratification and potentially reducing the need for invasive procedures. This narrative review, based on a structured literature search, synthesizes the evolution of post-AD colonoscopy recommendations, presents current evidence, and highlights future research directions on alternative diagnostic methods and their potential to optimize patient care and clinical decision-making.