Is Colonoscopy Still Mandatory After a CT Diagnosis of Left-Sided Diverticulitis: Can Colorectal Cancer be Confidently Excluded?

Lau, K C; Spilsbury, Katrina; Farooque, Yasser; Kariyawasam, Shashi; Owen, Robert; Wallace, M.; Makin, Gregory

doi:10.1097/dcr.0b013e31822899a2

Cited by 108 publications

(95 citation statements)

References 17 publications

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“…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].…”

Section: Discussionmentioning

confidence: 99%

Routine Screening for Colon Cancer after Conservative Treatment of Diverticulitis

Schout¹,

Bilgen²,

Groenen

2012

Dig Surg

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Background and Aims: It is generally advised to perform colonoscopy after conservatively treated diverticulitis because colon cancer may present itself with similar symptoms, laboratory and radiological results. With this study we investigated in what percentage of patients a malignancy was found by performing routine colonoscopy or radiologic imaging after a conservatively treated episode of diverticulitis, and whether this follow-up programme could be reserved for a selected group of patients. Methods: In our hospital, routine colonoscopy or, as a second choice, radiologic imaging has been standard practice over the last decade. We collected all colonoscopy and radiologic imaging results that were conducted of all 516 patients who were diagnosed with diverticulitis in this period. Results: Of those 516 patients, 378 had undergone colonoscopy, 45 radiologic imaging and 93 did not undergo any additional investigation. Eight cases of malignant neoplasia were found in those patients (2.1%), and an additional number of 40 adenomatous polyps (9.5%). Six out of 8 patients with colon cancer reported rectal blood loss, significant weight loss or persisting abdominal pain after being treated for diverticulitis. Conclusions: In patients who were conservatively treated with routine colonoscopy or radiologic imaging for apparent diverticulitis, a malignant tumour was found in the colon in 2.1% of them. If only performed in patients reporting alarm symptoms, a case of colon cancer would be missed in only 0.5% of patients conservatively treated for diverticulitis. Therefore, screening for colon cancer after conservative treatment of diverticulitis is only indicated in symptomatic patients.

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Section: Discussionmentioning

confidence: 99%

Routine Screening for Colon Cancer after Conservative Treatment of Diverticulitis

Schout¹,

Bilgen²,

Groenen

2012

Dig Surg

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“…In Australia [64], a slightly increased colon carcinoma rate (2.1%) was found within 1 year of CT-assisted diagnosis of left-sided diverticulitis. A systematic literature search on the benefit of colonoscopy from the perspective of the detection of colon carcinomas up to 24 weeks after CT diagnosis of diverticulitis identified 10 studies with 771 documented patients [65].…”

Section: History-taking Basic Diagnostic Procedures Differential DImentioning

confidence: 99%

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

134

117

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Background: Diverticular disease is one of the most common disorders of the gastrointestinal tract. 28-45% of the population develop colonic diverticula, while about 25% suffer symptoms and about 5% complications. Aim: To create formal guidelines for diagnosis and management. Methods: Six working groups with 44 participants analyzed key questions in subject areas assigned to them. Following a systematic literature search, 451 publications were included. Consensus was obtained by agreement within the working groups, two Delphi processes and a guideline conference. Results: Targeted management of diverticular disease requires a classificatory diagnosis. A new classification was created. In addition to the clinical examination, intestinal ultrasound or computed tomography is the determining factor. Interval colonoscopy is recommended to exclude comorbidities. A low-fiber diet, obesity, lack of exercise, smoking and immunosuppression have an adverse impact on diverticulosis. This can lead to diverticulitis. Antibiotics are no longer recommended in uncomplicated diverticulitis if no risk factors such as immunosuppression are present. If close monitoring is ensured, uncomplicated diverticulitis can be treated on an outpatient basis. Complicated diverticulitis should be treated in hospital, involving broad-spectrum antibiotic therapy, where necessary abscess drainage, and surgery, if possible laparoscopically. In the case of chronic relapsing diverticulitis, the risk of perforation decreases with each episode, so that surgery is no longer recommended after the second episode but only following individual assessment. Conclusions: New findings on diverticular disease call into question the overuse of antibiotics and excessive indications for surgery. Targeted treatment requires a precise diagnosis and intensive interdisciplinary cooperation. i 2014 S. Karger AG, Basel

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“…The vast majority of the studies draw the conclusion that colonoscopy after radiologically-confirmed uncomplicated diverticulitis is unnecessary to exclude malignancy [55][56][57][58][59][60], while it seems to be necessary after radiologically-confirmed complicated diverticulitis because the risk of malignancy in those patients is higher [61].…”

Section: Colonoscopy Following Acute Diverticulitismentioning

confidence: 99%

“…Granlund et al found an increased risk of colonic neoplasia (especially in the left colon) at 12 months but not in the long-term, recommending colonoscopy after an episode of diverticulitis [60]. Lau et al advised routine colonoscopy after an attack of diverticulitis in patients who have not had recent colonic evaluation, since the rate of colonic carcinoma is increased in those patients, especially in patients complaining for complicated diverticulitis [59]. Choi et al found that the yield of advanced colonic neoplasia was substantially higher in patients with acute diverticulitis than in asymptomatic, average-risk individuals.…”

Section: Colonoscopy Following Acute Diverticulitismentioning

confidence: 99%

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

Tursi

2015

JGLD

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Diverticulosis of the colon is frequently found on routine colonoscopy, and the incidence of diverticular disease and its complications appears to be increasing. The role of colonoscopy in managing this disease is still controversial.Colonoscopy plays a key role in managing diverticular bleeding. Several techniques have been effectively used in this field, but band ligation seems to be the best in preventing rebleeding. Colonoscopy is also effective in posing a correct differential diagnosis with other forms of chronic colitis involving colon harbouring diverticula (in particular with Crohn's disease or Segmental Colitis Associated with Diverticulosis). The role of colonoscopy to confirm diagnosis of uncomplicated diverticulitis is still under debate, since the risk of advanced colonic neoplasia in patients admitted for acute uncomplicated diverticulitis is not increased as compared to the average-risk population. On the contrary, colonoscopy is mandatory if patients complain of persistent symptoms or after resolution of an episode of complicated diverticulitis. Finally, a recent endoscopic classification, called Diverticular Inflammation and Complications Assessment (DICA), has been developed and validated. This classification seems to be a promising tool for predicting the outcome of the colon harboring diverticula, but further, prospective studies have to confirm its predictive role on the outcome of the disease.

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Is Colonoscopy Still Mandatory After a CT Diagnosis of Left-Sided Diverticulitis: Can Colorectal Cancer be Confidently Excluded?

Cited by 108 publications

References 17 publications

Routine Screening for Colon Cancer after Conservative Treatment of Diverticulitis

Routine Screening for Colon Cancer after Conservative Treatment of Diverticulitis

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

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