Endoscopic evaluation of the colon after an episode of diverticulitis: a call for a more selective approach

Abstract

There appears to be no benefit in performing routine colonic evaluation after an episode of diverticulitis as the incidence of colorectal cancer is almost equal to that of the general population. A more selective approach might therefore be justified. Potentially, only patients with persisting abdominal complaints after an episode of diverticulitis should be offered colonic evaluation to definitively exclude causal pathology.

Routine Screening for Colon Cancer after Conservative Treatment of Diverticulitis

“…The percentage of malignant tumours found in our study does not differ much from that in asymptomatic individuals. Besides colorectal carcinoma, one or more adenomatous polyps were found in 10.3% of the patients who underwent colonoscopy in our study, which is comparable to the number found in comparable studies [13][14][15][16]. These percentages are well below the number of adenomatous polyps found when colonoscopy is used for screening asymptomatic individuals, which is about 19% [18,19].…”

“…However, this advice is based only on expert opinion [11,12]. Recently, results have been published from retrospective studies [13][14][15][16] and one systematic review [17], showing a comparable yield from colonoscopy or other imaging studies after an episode of diverticulitis. In these studies malignant tumours were found in 0-2.8% of patients who underwent colonic imaging [13][14][15][16][17].…”

“…Recently, results have been published from retrospective studies [13][14][15][16] and one systematic review [17], showing a comparable yield from colonoscopy or other imaging studies after an episode of diverticulitis. In these studies malignant tumours were found in 0-2.8% of patients who underwent colonic imaging [13][14][15][16][17]. Two of these studies were performed in a similar design as ours; patients with clinical signs of diverticulitis were included, with or without radiological confirmation [13,15].…”

“…In these studies malignant tumours were found in 0-2.8% of patients who underwent colonic imaging [13][14][15][16][17]. Two of these studies were performed in a similar design as ours; patients with clinical signs of diverticulitis were included, with or without radiological confirmation [13,15]. In two studies by Lau et al [16] and Westwood et al [14], patients were included from a CT scan database.…”

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

“…This approach would allow a more efficient use of limited resources for CRC screening given the current long wait times for colonoscopy in Canada. 27 Using a selective approach, colonoscopy would be offered to those 50 years of age or older who had not undergone previous CRC screening, those with a protracted course or recurrence of diverticulitis despite medical therapy 28 and those with suspicious CT findings, such as a mass lesion with obstruction. 26 …”