A joint guideline from the European Association for Endoscopic Surgery and SAGES, built on a systematic review of 27 studies and a GRADE evidence-to-decision process with surgeons, gastroenterologists and patient partners. Published in Surgical Endoscopy on 14 October 2026.
The panel made five conditional recommendations: rifaximin or mesalamine over supportive care alone for symptomatic uncomplicated diverticular disease; no routine antibiotics in uncomplicated diverticulitis; elective resection over observation for persistent symptoms after recurrent uncomplicated episodes; no routine follow-up colonoscopy after recovery from a first uncomplicated episode; and elective resection over surveillance after recovery from diverticulitis complicated by an abscess.
The evidence was very low to moderate certainty, and data were lacking on several outcomes patients value, including emergency surgery and stoma-free survival. The panel therefore framed each recommendation as a shared decision. For many clinicians, two of these will change practice most: withholding antibiotics in a well, immunocompetent patient with CT-confirmed uncomplicated disease, and not booking a colonoscopy reflexively after a first episode, as long as the CT was diagnostic and there are no other indications.
- Consider managing CT-confirmed uncomplicated diverticulitis without antibiotics in well, immunocompetent patients
- Do not book a routine colonoscopy after a first uncomplicated episode unless other indications exist
- Discuss elective resection after recovery from diverticulitis with an abscess
- Offer elective resection for persistent symptoms after recurrent episodes, weighing the patient's priorities
- Use antibiotics where there is sepsis, immunosuppression or a complicated picture
Why it matters
It moves two reflexes, antibiotics and colonoscopy, from default to decision.
Don't overread it
All five recommendations are conditional and based on low-certainty evidence; they support shared decisions, not mandates.
The statistics, in plain English
A conditional recommendation means most informed patients would choose the suggested option but a substantial minority would not. Very low certainty means further research could change the answer.
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