Patients with computed tomography-proven acute diverticulitis require follow-up to exclude colorectal cancer

Zaman, Shafquat; Chapman, Warren; Mohammed, I; Gill, Kathryn; Ward, Steve

doi:10.5217/ir.2017.15.2.195

Cited by 12 publications

(30 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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. Twelve studies did not report the proportion of left‐sided diverticulitis, but were conducted in the West. Most studies included all patients with acute diverticulitis; two included only patients with uncomplicated diverticulitis.…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies excluded patients who underwent colonoscopy before (varying from 6 months to 2 years) the diagnosis of acute diverticulitis. Colorectal carcinoma was reported in all 17 studies. Eight studies used the correct definition of advanced adenoma and could therefore be used for analysis of ACN (colorectal carcinoma and advanced adenoma combined).…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies, including 43 patients with colorectal carcinoma, reported the location of the carcinoma. Almost all tumours (41 of 43) were found at the site of the presumed acute diverticulitis.…”

Section: Resultsmentioning

confidence: 99%

“…Andrade et al 31 Brar et al 32 Chabok et al 26 Choi et al 33 Daniels et al 34 Elmi et al 35 Hjern et al 27 Lahat et al 28 Lau et al 36 Lecleire et al 37 Ou et al 38 Sakhnini et al 29 Sallinen et al 39 Schmilovitz-Weiss et al 40 Suhardja et al 41 Zaman et al 42 252 249 101 23 401 140 51 86 319 404 114 93 394 100 270 100 0·005 (0·000, 0·028) 0·032 (0·014, 0·062) 0·016 (0·004, 0·041) 0·000 (0·000, 0·036) 0·087 (0·011, 0·280) 0·012 (0·004, 0·029) 0·057 (0·025, 0·109) 0·000 (0·000, 0·070) 0·000 (0·000, 0·042) 0·028 (0·013, 0·053) 0·002 (0·000, 0·014) 0·035 (0·010, 0·087) 0·022 (0·003, 0·076) 0·023 (0·010, 0·043) 0·000 (0·000, 0·036) 0·019 (0·006, 0·043) 0·010 (0·000, 0·054)…”

Section: Weight (%)mentioning

confidence: 99%

See 4 more Smart Citations

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

Rottier

Dijk

Geloven

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

Background Routine colonoscopy was traditionally recommended after acute diverticulitis to exclude coexistent malignancy. Improved CT imaging may make routine colonoscopy less required over time but most guidelines still recommend it. The aim of this review was to assess the role of colonoscopy in patients with CT‐proven acute diverticulitis. Methods PubMed and Embase were searched for studies reporting the prevalence of advanced colorectal neoplasia (ACN) or colorectal carcinoma in patients who underwent colonoscopy within 1 year after CT‐proven left‐sided acute diverticulitis. The prevalence was pooled using a random‐effects model and, if possible, compared with that among asymptomatic controls. Results Seventeen studies with 3296 patients were included. The pooled prevalence of ACN was 6·9 (95 per cent c.i. 5·0 to 9·4) per cent and that of colorectal carcinoma was 2·1 (1·5 to 3·1) per cent. Only two studies reported a comparison with asymptomatic controls, showing comparable risks (risk ratio 1·80, 95 per cent c.i. 0·66 to 4·96). In subgroup analysis of patients with uncomplicated acute diverticulitis, the prevalence of colorectal carcinoma was only 0·5 (0·2 to 1·2) per cent. Conclusion Routine colonoscopy may be omitted in patients with uncomplicated diverticulitis if CT imaging is otherwise clear. Patients with complicated disease or ongoing symptoms should undergo colonoscopy.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Weight (%)mentioning

confidence: 99%

See 3 more Smart Citations

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

Rottier

Dijk

Geloven

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

Short‐ and Long‐Term Outcomes of Right‐Sided Diverticulitis: Over 15 Years of North American Experience

et al. 2020

View full text Add to dashboard Cite

Background Right‐sided colonic diverticulitis represents less than 5% of diverticulitis cases in North America. The purpose of this study was to describe the management and outcomes for patients with a first episode of right‐sided diverticulitis in a North American center. Methods This was a retrospective cohort study, including all patients managed for right‐sided diverticulitis at a single tertiary‐care institution from 2000 to 2017. Patient demographics, disease characteristics, and treatment strategies were described. Short‐ (emergency surgery, operative morbidity, treatment failure) and long‐term (recurrence, elective operation) outcomes were reported. Patients with right‐sided diverticulitis were then compared to a cohort of patients with left‐sided diverticulitis. Results Sixty‐seven patients were managed for a first episode of right‐sided diverticulitis, three (4.5%) of which were subsequently diagnosed with right‐sided colon cancer; 64 patients therefore formed the population. Mean age was 51.2 ± 17.7 years. Eight patients (12.5%) self‐identified as being Asian. The majority of patients had uncomplicated disease (90.6%); six (9.4%) presented with complicated diverticulitis. Most cases were diagnosed by computed tomography (78.1%), while 17.2% were diagnosed intra‐operatively and 4.7% by pathology. Almost all patients diagnosed by computed tomography were managed nonoperatively. Fifteen patients (23.4%) were managed surgically: ten for suspected appendicitis, three for suspected colon mass, and two for diffuse peritonitis. After a median follow‐up of 74.8 months (IQR 30.2–130.5), only two patients (3.1%) developed recurrent right‐sided diverticulitis. Among patients managed nonoperatively, recurrence was significantly lower in patients with right‐sided diverticulitis relative to left‐sided diverticulitis (4.1% vs. 32.8%, p < 0.001). Conclusions Right‐sided diverticulitis can be successfully managed nonoperatively with low rates of recurrence. In populations in which this condition is more seldom observed, underlying colon cancers should be considered.

show abstract

Ambulatory management of acute uncomplicated diverticulitis (AmbUDiv study): a multicentre, propensity score matching study

Mohamedahmed,

Hamid,

Issa

et al. 2024

Int J Colorectal Dis

View full text Add to dashboard Cite

Introduction Recent studies have suggested that ambulatory management is feasible for acute uncomplicated diverticulitis (AUD); however, there is still no consensus regarding the most appropriate management settings. This study presents a multi-centre experience of managing patients presenting with AUD, specifically focusing on clinical outcomes and comparing ambulatory treatment with in-patient management. Methods A retrospective multi-centre study was conducted across four hospitals in the UK and included all adult patients with computed tomography (CT) confirmed (Hinchey grade 1a) acute diverticulitis over a 12-month period (January – December 2022). Patient medical records were followed up for 1-year post-index episode, and outcomes were compared between those treated through the ambulatory pathway versus inpatient treatment using 1:1 propensity score matching (PSM). All statistical analysis was performed using the R Foundation for Statistical Computing, version 4.4. Results A total of 348 patients with Hinchey 1a acute diverticulitis were included (260 in-patients; 88 ambulatory pathway), of which nearly a third (31.3%) had a recurrent disease. Inpatient management was dominant (74.7%), with a median of 3 days of hospital stay. PSM resulted in 172 patients equally divided between the two care settings. Ambulatory management was associated with a lower readmission rate (P = 0.02 before PSM, P = 0.08 after PSM), comparable surgical (P = 0.57 before PSM, 0% in both groups after PSM) and radiological interventions (P = 0.99 before and after PSM) within one year. In both matched and non-matched groups, a strong association between readmissions and inpatient management was noted in univariate analysis (P = 0.03 before PSM, P = 0.04 after PSM) and multivariate analysis (P = 0.02 before PSM, P = 0.03 after PSM). Conclusion Our study supports the safety and efficacy of managing patients with AUD through a well-designed ambulatory care pathway. In particular, hospital re-admission rates are lower and other outcomes are non-inferior to in-patient treatment. This has implications for substantial cost-savings and better utilisation of limited healthcare resources.

show abstract

Patients with computed tomography-proven acute diverticulitis require follow-up to exclude colorectal cancer

Cited by 12 publications

References 22 publications

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

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

Short‐ and Long‐Term Outcomes of Right‐Sided Diverticulitis: Over 15 Years of North American Experience

Ambulatory management of acute uncomplicated diverticulitis (AmbUDiv study): a multicentre, propensity score matching study

Contact Info

Product

Resources

About