Colonic
diverticular disease has been increasing in
prevalence in
Japan due to the rapidly
aging population. Colonic
diverticular bleeding can result in
hemorrhagic shock requiring
blood transfusion, and it carries a high
risk of
recurrence within 1 year.
Colonic diverticulitis can cause
abscess,
fistula formation, and perforation of the
colon that may require
surgery, and it often recurs. As a result,
patients with colonic
diverticular disease are often bothered by required frequent examinations, re-
hospitalization, and a consequent decrease in
quality of life. However, the management of
diverticular disease differs between
Japan and Western countries. For example, computed
tomography (CT) is readily accessible at
Japanese hospitals, so urgent CT may be selected as the first diagnostic
procedure for suspected
diverticular disease. Endoscopic clipping or band
ligation may be preferred as the first endoscopic
procedure for
diverticular bleeding.
Administration of
antibiotics and complete bowel
rest may be considered as first-line
therapy for
colonic diverticulitis. In addition,
diverticula occur mainly in the
sigmoid colon in Western countries, whereas the right side or bilateral of the
colon is more commonly involved in
Japan. As such,
diverticular disease in the right-side
colon is more prevalent in
Japan than in Western countries. Against this background, concern is growing about the management of colonic
diverticular disease in
Japan and there is currently no
practice guideline available. To
address this situation, the
Japanese Gastroenterological
Association decided to create a clinical
guideline for colonic
diverticular bleeding and
colonic diverticulitis in collaboration with the
Japanese Society of
Gastroenterology,
Japan Gastroenterological
Endoscopy Society, and
Japanese Society of
Interventional Radiology. The steps taken to establish this
guideline involved incorporating the concept of the GRADE system for rating
clinical guidelines, developing clinical questions (CQs), accumulating evidence through a
literature search and
review, and developing the Statement and Explanation sections. This
guideline includes 2CQs for
colonic diverticulosis, 24 CQs for colonic
diverticular bleeding, and 17 CQs for
diverticulitis.