Efficacy of colonoscopy after an episode of acute diverticulitis and risk of colorectal cancer

Abstract

Background Diverticular disease of the colon has a high global prevalence. The guidelines suggest performing a colonoscopy 4-6 weeks after the acute episode to exclude colorectal cancer (CRC). However, these recommendations are based on old studies, when computed tomography was not used to diagnose acute diverticulitis (AD). There are currently some studies showing that CRC incidence is low in uncomplicated AD (UAD). Therefore, we decided to perform this study to determine the CRC incidence after an AD episode and the diagnostic efficacy of colonoscopy in these patients. Method This was a retrospective cohort study that included patients with AD between July 2016 and December 2017. Results One hundred seventy-four patients had AD. Of these, 46 patients were excluded and we analyzed 128 patients, 72 (56.3%) women and 56 (43.7%) men. Ninety (70.3%) had UAD and 38 (29.7%) complicated AD (CAD). The colonoscopy showed lesions in 18 (14.06%), 5 (3.9%) being CRC. The patients with CRC had shown CAD and were >70 years old (P=0.0001 and P=0.002 respectively). Conclusions Routine colonoscopy in patients with UAD appears not have many benefits as a diagnostic tool. However, it has a higher efficacy if the patients have CAD and are >70 years old.

Colonoscopy and flexible sigmoidoscopy for follow-up of patients with left-sided diverticulitis

“…[7][8][9][10][11][12] However, it can be beneficial in cases of complicated diverticulitis or continuing symptoms, and in patients aged over 70 years, because the risk of malignancy in these patients is higher. [7][8][9]13 In contrast, the Association of Coloproctology of Great Britain and Ireland (ACPGBI) has recommended that all patients require investigation of the colonic lumen by endoscopy, barium enema or CT colonography after the acute attack of diverticulitis has resolved. 4 Many studies have compared the use of flexible sigmoidoscopy with colonoscopy as a screening investigation for colorectal cancer, but we are not aware of previous studies compared the use of flexible sigmoidoscopy and colonoscopy as a follow-up investigation for diverticulitis.…”

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

“…There were ten high quality studies which scored greater than or equal to 7 (see Tables S1, S2). 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).…”

“…25,30,35,49,50,59,60,62,63,78,85,89 There were 13 296 patients from 65 studies who underwent a follow up colonoscopy. 6,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][67][68][69][70][71][72][73][74][75][76][77][78][79][81][82][83][84][85][86][87][88]…”

“…[1][2][3] With the widespread use of high-resolution CT to evaluate patients with clinical diverticulitis in most western countries, the need for an interval colonoscopy has been increasingly questioned especially in uncomplicated diverticulitis. [5][6][7] While all guidelines recommend endoscopic follow up in complicated diverticulitis, varied interpretations of the literature on uncomplicated diverticulitis have resulted in conflicting recommendations across the world. The American Gastroenterological Association and the Japan Gastroenterological Association recommend a follow up colonoscopy while the American Society of Colon and Rectal Surgeons, World Society of Emergency Surgery and the Association of Coloproctology of Great Britain & Ireland do not.…”

A selective approach for colonoscopy after acute diverticulitis

“…In their interesting recent paper in the Annals of Gastroenterology, Díaz et al [1] reported no cases of colorectal cancer (CRC) or advanced adenomas in patients with uncomplicated acute diverticulitis (UAD) confirmed by computed tomography (CT). All patients diagnosed with CRC (n=5) presented complicated disease and were older than 70 years.…”