Colonoscopy After Computed Tomography–diagnosed Acute Right-sided Diverticulitis May Be Unnecessary

Hashimoto, Rintaro; Matsuda, Tomoki; Chonan, Akimichi

doi:10.1097/mcg.0000000000000516

Cited by 6 publications

(11 citation statements)

References 3 publications

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“…A total of 68 studies with 13 905 patients were included 6,24–90 . There were four prospective studies and one retrospective review of a prospective study 44,60,61,77,89 .…”

Section: Resultsmentioning

confidence: 99%

“…6,25,40,41,44,49,58,63,65,78 Follow up was greater than 80% in 25 studies. 25,29,[31][32][33]39,41,44,45,49,[53][54][55]60,61,63,67,71,74,[77][78][79][80]86,89 Primary study outcomes Colorectal cancers were identified in 2.0% (95% CI 1.67-2.40) of patients undergoing interval colonoscopy or flexible sigmoidoscopy after acute diverticulitis in 68 studies (see Table 1). 6, The distribution of cancers was 27.9% sigmoid/descending colon, 9.0% proximal to splenic flexure, 3.7% in rectum and 59.4% with location not reported.…”

Section: Study Demographicsmentioning

confidence: 99%

“…24,32,38,43,44,50,51,53,56,62,64,[69][70][71][72]77,78,80,81,85,88 Non advanced adenomas detection rate was 17.1% (1247/7283) from 46 studies. 6,24,[26][27][28][29][30][31]36,37,[39][40][41][42]44,[47][48][49][50]52,53,55,[57][58][59][60][61][62][63][64][65][67]…”

Section: Other Intraluminal Findingsmentioning

confidence: 99%

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Endoscopic findings after CT proven acute diverticulitis: a systematic review and meta‐analysis

Cao

Lam

Rickard

2022

ANZ Journal of Surgery

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Background Traditionally, international guidelines recommend patients with acute diverticulitis should be followed up with a colonoscopy 6–8 weeks after discharge. However, the need for an interval colonoscopy has been increasingly challenged in the setting of computed tomography (CT). Previous meta‐analyses have included studies which combined suspected rather than imaging confirmed diverticulitis and often without correlation with endoscopic findings. This meta‐analysis aims to investigate endoscopic findings of patients with CT confirmed diverticulitis. Methods An electronic search of Medline, PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus, Clinicaltrials.gov and WHO ICTRP was performed up to October 18, 2021. Studies which reported CT confirmed acute diverticulitis in adults and who underwent endoscopic follow‐up with either a colonoscopy or flexible sigmoidoscopy were included. Studies were excluded if diverticulitis was diagnosed by clinical grounds alone, ultrasound, barium enema, or other non‐CT forms of imaging. Results A total of 68 studies with 13 905 patients were included. Median age was 58 years and male to female ratio was 0.84. Cancer was detected in 2.0% and advanced adenoma in 3.8%. Complicated diverticulitis had 9.2 higher odds of cancer compared to uncomplicated diverticulitis (95% CI 4.42–19.08, P < 0.001). Adenomas were detected in 17%. Of those diagnosed with colorectal cancer, 85% were concordant with the site of the diverticulitis on CT while 15% were incidental findings. Conclusion Routine colonoscopic follow up should be recommended in medically fit patients who have CT proven acute diverticulitis due to the higher than population prevalence of colorectal cancer and advanced adenomas.

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“…A total of 68 studies with 13 905 patients were included 6,24–90 . There were four prospective studies and one retrospective review of a prospective study 44,60,61,77,89 .…”

Section: Resultsmentioning

confidence: 99%

Section: Study Demographicsmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic findings after CT proven acute diverticulitis: a systematic review and meta‐analysis

Cao

Lam

Rickard

2022

ANZ Journal of Surgery

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“…However, the majority of this evidence included only patients with left colon diverticulitis. In fact, to our knowledge, only two previous studies addressed right colon diverticulitis [15,16] . In their study of 109 patients with right-sided colon diverticulitis, Hashimoto et al did not identify any cases of colorectal cancer, with a rate of advanced adenoma of 6.4% (7/109 cases) and non-advanced adenoma of 21.1% (23/109 cases) [16].…”

Section: Discussionmentioning

confidence: 99%

“…In fact, to our knowledge, only two previous studies addressed right colon diverticulitis [15,16] . In their study of 109 patients with right-sided colon diverticulitis, Hashimoto et al did not identify any cases of colorectal cancer, with a rate of advanced adenoma of 6.4% (7/109 cases) and non-advanced adenoma of 21.1% (23/109 cases) [16]. Chan et al reported on 27 patients with right colon diverticulitis, with no incidence of colorectal cancer or advanced adenoma identi ed [15].…”

Section: Discussionmentioning

confidence: 99%

Routine colonoscopy may be needed for uncomplicated acute right colonic diverticulitis

Lee

Park

et al. 2020

Preprint

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BACKGROUND: Routine colonoscopy is recommended to determine the coexistence of colon cancer after medical treatment for colon diverticulitis. However, in the case of uncomplicated diverticulitis diagnosed by computed tomography imaging, the clinical relevance of routine follow-up colonoscopy has recently been debated. Yet, the role of follow-up colonoscopy for right colon diverticulitis, which tends to develop at a younger age than left colon diverticulitis, has not been specifically evaluated. Therefore, our aim in this study was to evaluate the incidence of right colon cancer or colonic adenomatous polyps, detected by routine colonoscopy, after conservative management of acute uncomplicated right colon diverticulitis. METHODS: Included were patients with uncomplicated right colon diverticulitis diagnosed by computed tomography imaging, between 2011 and 2017, and who underwent follow-up colonoscopy surveillance after treatment. The primary outcome was the incidence of colon cancer, with the detection rate of adenoma being the secondary outcome. Information for analysis was retrieved, retrospectively, from patients’ medical records. RESULTS: The study group included 330 consecutive patients, with a mean age of 41.9 years, and 51.9% being men. For the primary outcome, the rate of colon cancer on follow-up colonoscopy was 0.3% (1/330 cases). The rate of adenoma detection was 20.9% (69/330 cases), with advanced adenoma, including colon cancer, observed in 9 patients (2.7%). CONCLUSION: In patients with acute uncomplicated right colonic diverticulitis, routine colonoscopy after conservative treatment may be necessary because although the colon cancer detection rate is low, it is possible to detect advanced colon adenoma.

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Short‐ and Long‐Term Outcomes of Right‐Sided Diverticulitis: Over 15 Years of North American Experience

et al. 2020

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Background Right‐sided colonic diverticulitis represents less than 5% of diverticulitis cases in North America. The purpose of this study was to describe the management and outcomes for patients with a first episode of right‐sided diverticulitis in a North American center. Methods This was a retrospective cohort study, including all patients managed for right‐sided diverticulitis at a single tertiary‐care institution from 2000 to 2017. Patient demographics, disease characteristics, and treatment strategies were described. Short‐ (emergency surgery, operative morbidity, treatment failure) and long‐term (recurrence, elective operation) outcomes were reported. Patients with right‐sided diverticulitis were then compared to a cohort of patients with left‐sided diverticulitis. Results Sixty‐seven patients were managed for a first episode of right‐sided diverticulitis, three (4.5%) of which were subsequently diagnosed with right‐sided colon cancer; 64 patients therefore formed the population. Mean age was 51.2 ± 17.7 years. Eight patients (12.5%) self‐identified as being Asian. The majority of patients had uncomplicated disease (90.6%); six (9.4%) presented with complicated diverticulitis. Most cases were diagnosed by computed tomography (78.1%), while 17.2% were diagnosed intra‐operatively and 4.7% by pathology. Almost all patients diagnosed by computed tomography were managed nonoperatively. Fifteen patients (23.4%) were managed surgically: ten for suspected appendicitis, three for suspected colon mass, and two for diffuse peritonitis. After a median follow‐up of 74.8 months (IQR 30.2–130.5), only two patients (3.1%) developed recurrent right‐sided diverticulitis. Among patients managed nonoperatively, recurrence was significantly lower in patients with right‐sided diverticulitis relative to left‐sided diverticulitis (4.1% vs. 32.8%, p < 0.001). Conclusions Right‐sided diverticulitis can be successfully managed nonoperatively with low rates of recurrence. In populations in which this condition is more seldom observed, underlying colon cancers should be considered.

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Colonoscopy After Computed Tomography–diagnosed Acute Right-sided Diverticulitis May Be Unnecessary

Cited by 6 publications

References 3 publications

Endoscopic findings after CT proven acute diverticulitis: a systematic review and meta‐analysis

Endoscopic findings after CT proven acute diverticulitis: a systematic review and meta‐analysis

Routine colonoscopy may be needed for uncomplicated acute right colonic diverticulitis

Short‐ and Long‐Term Outcomes of Right‐Sided Diverticulitis: Over 15 Years of North American Experience

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