Findings on Colonoscopy after Diverticulitis: A Multicenter Review

Abstract

Diverticular disease is a common problem where patients with diverticulosis have a 1–4 per cent risk of acute diverticulitis. Current guidelines recommend a colonoscopy after.the resolution of acute diverticulitis. The aim of this study was to evaluate the yield of significant findings on colonoscopy after an episode of diverticulitis. This is a retrospective analysis of patients who underwent colonoscopy after an episode of diverticulitis between November 2005 and August 2017 at three major teaching hospitals. Advanced adenomas were defined as adenomas ≥1 cm, serrated adenomas, and tubulovillous or villous adenomas. A total of 584 patients (298 males; 51%) underwent colonoscopy for a history of diverticulitis after resolution of acute symptoms. Colonoscopy was complete in 488 patients (84%). Among these 488 patients, 446 had diverticular disease, 31 had advanced adenomas, and four had adenocarcinomas. Colonoscopies were incomplete in 96 patients (16%). Forty-six of those patients underwent surgery. The overall incidence of advanced adenomas and adenocarcinomas was 32 (5.4%) and nine (1.5%), respectively. In our study, the prevalence of advanced adenomas and adenocarcinomas was relatively high compared with the average risk individuals. Our findings support that patients after an episode of diverticulitis should continue to get a colonoscopy.

Management of Colonic Diverticulitis

“…Three of these compared colonoscopy to no colonoscopy in patients with recent diverticulitis, 103-105 three compared colonoscopy in patients with recent diverticulitis to healthy controls, 106-108 one compared early (in-hospital) colonoscopy to later colonoscopy, 109 and 13 were single-group studies of patients who underwent colonoscopy. [110][111][112][113][114][115][116][117][118][119][120][121][122] Appendix C Tables C-3-1 to C-3-4 give descriptions of the studies; results are in Appendix D Tables D-3-1 to D-3-7. An additional study of interest that did not meet eligibility criteria is also discussed together with the comparative studies.…”

“…We identified 13 single group studies, all retrospective, that evaluated colonoscopy outcomes. [110][111][112][113][114][115][116][117][118][119][120][121][122] The 13 studies were each conducted at a single center and all patients received followup colonoscopy after treatment of acute diverticulitis treatment. The mean age of participants across studies ranged from 41 to 64 years old.…”

“…There was no clear pattern by country (or continent); for example, the two studies with the lowest and highest rates of CRC were both conducted in Israel. The three studies conducted in the U.S. (Elmi 2013, Alcantar 2019, and Studniarek 2019 had estimates of CRC ranging from 0 to 2.2 percent.…”

“…Eight studies reported on rates of advanced adenoma (Figure 7 and Appendix Figure D-3-3). 105,106,108,110,111,118,119,122 Most studies defined advanced adenomas as either large (≥10 mm), villous, or of high grade. Lecleire 2014 also included invasive cancer, but for our analysis, we have excluded the one patient with CRC.…”

“…Brar 2013 and Studniarek 2019 found correspondingly higher estimates of advanced adenoma that included serrated polyps: 9.2 percent (95% CI 5.9 to 13.5) and 5.5 percent (95% CI 3.9 to 7.6), respectively. 111,122…”