Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary?

Abstract

Background: Computed tomography (CT) scans are commonly used to diagnose acute diverticulitis, but there are overlapping features between diverticulitis and colorectal cancer (CRC) on imaging studies. Hence, colonoscopy is typically recommended after an episode of acute diverticulitis to rule out underlying malignancy. Currently, 64-slice multidetector CT scanners are capable of providing higher-resolution images and may be able to distinguish malignancy from diverticular inflammation. We aimed to determine the prevalence of CRC among patients with CT-diagnosed acute diverticulitis. Methods:We performed a retrospective study of patients with acute diverticulitis diagnosed on CT scan between December 2005 and December 2010 at St. Paul's Hospital, Vancouver, BC. Nonresidents were excluded. We reviewed CT scan reports that included the term "diverticulitis," reports of follow-up colonic evaluation within 1 year of diagnosis and pathology results. We queried the provincial cancer registry to ensure no cases of CRC were missed.Results: A total of 293 patients had acute diverticulitis diagnosed on CT scan, but 8 were nonresidents and were excluded. Of the 285 included in the analysis, the mean age was 59.4 ± 15.1 years, and 167 (58.6%) were men. Among the 114 patients who underwent follow-up evaluation, malignancy was diagnosed in 4 (3.5%). The overall prevalence of malignancy among patients with CT-diagnosed diverticulitis was 1.4%. Conclusion:Routine endoscopic evaluation after an episode of diverticulitis diagnosed with high-resolution CT scan does not appear to be necessary. Selective approach in patients with protracted clinical course or those with mass lesion/ obstruction on CT scan may be of benefit.Contexte : La tomodensitométrie (TDM) est couramment utilisée pour le diagnostic de la diverticulite aiguë, mais des caractéristiques sont communes à la diverticulite et au cancer colorectal (CCR) aux épreuves d'imagerie. On recommande donc en général la coloscopie après un épisode de diverticulite aiguë pour écarter un diagnostic de cancer sous-jacent. À l'heure actuelle, les appareils de TDM multidétecteurs à 64 barrettes peuvent fournir des images de haute résolution et permettent même de distinguer le cancer d'une inflammation diverticulaire. Nous avons voulu déterminer la prévalence du CCR chez les patients ayant présenté une diverticulite aiguë diagnostiquée par TDM. Résultats : En tout, 293 patients ont reçu un diagnostic de diverticulite à l'aide de la TDM; 8 étaient des non-résidents et ont été exclus. Parmi les 285 patients inclus dans l'analyse, l'âge moyen était de 59,4 ± 15,1 ans et 167 (58,6 %) étaient des hommes. Parmi les 114 patients qui ont subi un examen de suivi, le cancer a été diagnostiqué chez 4 (3,5 %). La prévalence globale du cancer chez les patients porteurs d'un diagnostic de diverticulite posé par TDM était de 1,4 %. Conclusion :L'évaluation endoscopique de routine après un épisode de diverticulite diagnostiquée à l'aide d'une TDM de haute résolution ne semble pas nécessaire. Une approc...

Evaluating if colonoscopies are essential after a diverticulitis diagnosis

“…Our retrospective study 1 demonstrates that the prevalence of malignancy among patients with diverticulitis diagnosed on high-resolution (64-slice) CT scan was 1.4%, similar to that of average-risk population. 2 The data period was chosen based on the time when high-resolution CT came into widespread use.…”

“…It was with great interest that we read the work of George Ou and colleagues 1 regarding Colonoscopy after CT-diagnosed acute diverticulitis published June 1, 2015. While this paper explores a very relevant and topical subject there are a few issues we would like to highlight.…”

Meta-analysis of the role of colonoscopy after an episode of left-sided acute diverticulitis

“…All studies were published after 2003. There were four prospective cohort studies and 13 retrospective cohort studies ( Table ). Four studies included only patients with left‐sided acute diverticulitis, and only the subgroup of patients with left‐sided diverticulitis from one Korean study was included in the present review.…”

Tumour Characteristics of Patients with Colorectal Cancer after Acute Uncomplicated Diverticulitis

“…They only suggest a colonoscopy when there are potential clues on CT findings that could lead to CRC, such as an increase in intestinal wall thickness more than 6 mm, abscess, obstruction or lymph node abnormalities. When a CT-confirmed diverticlutis is in the absence of other concering or intermediate findings, there is no benefit in a follow-up colonoscopy [23][24][25][26]. Recently, 3 meta-analyses were published concerning the risk of CRC after a radiologic confirmed diagnosis of acute diverticulitis.…”