Prevalence of colorectal cancer in acute uncomplicated diverticulitis and the role of the interval colonoscopy

Abstract

Prevalence of colorectal cancer in patients with CT-proven acute uncomplicated diverticulitis may not be as low as previously suggested. We recommend that patients with acute uncomplicated diverticulitis continue to be offered interval colonoscopy until larger studies demonstrate the safety of omission.

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

“…Currently, most international clinical guidelines, as well as the American Gastroenterological Association [13] and the Society of American Gastrointestinal and Endoscopic Surgeons [14], recommend performing a routine colonoscopy or CT colonography after an episode of AD to exclude the presence of CRC. However, nowadays these recommendations are controversial, because they were based on old studies in which the diagnosis of AD was determined by clinical, analytical and imaging tests—such as barium enema, abdominal ultrasound, and CT—that were of inferior quality and resolution compared to current modalities [5,15-17]. In addition, invasive procedures are not exempt from complications and they entail a risk of morbidity and mortality.…”

“…Nowadays, CT has revolutionized the diagnosis and management of colonic diverticular disease. Multidetector CT can obtain thinner sections and has a better resolution and images of higher quality [6,17]. It is presently considered the best imaging technique for the diagnosis of AD and its complications, with a sensitivity and specificity of 94% and 99% respectively [4,18,19].…”

Author response to Comment on: Meta-analysis of the role of colonoscopy after an episode of left-sided acute diverticulitis

“…at least three of the five patients with CRC actually had localized perforation and/or an abscess. Furthermore, Soh et al . include only a very small number of patients with left‐sided acute diverticulitis (54 of 227).…”

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

“…Moreover, Soh et al . recently reported a prevalence of CRC of 1·8 per cent in 227 patients with uncomplicated diverticulitis and recommended to continue performing endoscopy to exclude colorectal cancer.…”