Review for 10.1186/s12876-021-01672-1 (2021)

Reviewer’s report
Title: 
Routine colonoscopy may be needed for uncomplicated acute right colonic
diverticulitis
Version: 
1 
Date: 
30 Jun 2020
Reviewer's report:
Manuscript Revision - Routine colonoscopy may not be needed for
uncomplicated acute right colonic diverticulitis
Interesting and important study on follow up colonoscopy following right sided
colonic diverticulitis, as the majority of published studies on this subject deals
with left sided acute diverticulitis, as the authors mention in the discussion. The
article is well written and concise, although a few details are missing in my
opinion - 
1. The biggest flaw in my opinion is the fact that the authors include patients
with Hinchey grade 1a in their analysis of uncomplicated disease. The authors
should separate all patients with complicated disease and uncomplicated disease
and re-perform the analysis, as evidence shows that complicated disease
(including Hinchey 1a) carries a significantly higher rate of CRC compared to
uncomplicated disease (see the meta-analysis by Meyer et al in clinical
gastroenterology an hepatology, 2019). 
2. Can the authors elaborate on why they chose to compare between patients who
had a colonoscopy and patients who didn't (Table 1) ? how is this relevant to the
study aim?
3. In the conclusion, the authors state that colonoscopy isn't warranted for
patients with uncomplicated right sided diverticulitis, however the rate of
adenoma detection and advanced adenoma detection are fairly high - doesn't that
justify the need to perform a colonoscopy and prevent an advancement to a
malignancy? 
4. Another interesting detail needs to be added - in how many patients who
underwent colonoscopy were diverticuli actually seen? In some of the studies the
authors mention in the discussion the rated of diverticular disease in colonoscopy
evaluation was only around 70-80% of patients, meaning that the reason for the
colonic inflammation was actually different. Would that affect the long-term
management of these patients?
5. In addition to the last couple of comments - can the authors add their opinion
about the management of patients following right sided diverticulitis - what is
the maximal interval of time between a prior colonoscopy and a recommendation
for a new endoscopic evaluation; their recommendation for complicated disease
and in which cases will they insist on performing a colonoscopy.
6. I think more clinical details are needed - which patients had a recurring
disease, on longer follow up how many patients underwent surgery etc.
7. The authors mention that 35% of patients who did not undergo colonoscopy
(Table 3) had a scheduled colonoscopy that wasn't performed yet - the study
include patients from 2011-2017 - are there patients who were scheduled for
colonoscopy and waiting for it for 4 years?!
Overall I thank the authors for an interesting read and I want to congratulate
them for their work. 
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No
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Yes
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Unable to assess
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No
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Not relevant to this manuscript
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Acceptable
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