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. 
Publons Reviewer Recognition
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No
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my
report.
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. 
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my
report.
Please review this paper.
user
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. 
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my
report.
assistant