Risk of colorectal adenomas, advanced adenomas and cancer in patients with colonic diverticular disease: Systematic review and meta‐analysis

Abstract

Background and Aim: Diverticular disease and colorectal neoplasia are common digestive disorders worldwide. Both diseases share epidemiological trends and certain risk factors including advancing age, physical inactivity, and Western diet and lifestyle. Studies assessing the association between these diseases reported inconsistent results. Thus, we conducted a systematic review and meta-analysis to determine the association between diverticular disease and colorectal adenomas, advanced adenomas and cancer.Methods: A comprehensive search of the databases MEDLINE and EMBASE was done from inception through March 2016. Inclusion criterion was the observational studies' assessment of the association between diverticular disease and colorectal neoplasia in adult participants. Pooled OR and 95% confidence interval (CI) were calculated using a random effect.Results: Data were extracted from 14 observational studies (11 cross-sectional studies, one case-control study and two cohort studies). Diverticular disease was associated with increased odds of adenomas (OR = 1.67, 95% CI 1.27-2.21, 10 studies), but not associated with advanced adenomas (OR = 1.19, 95% CI 0.88-1.62, I 2 = 52%, four studies) or colorectal cancer (OR = 1.36, 95% CI 0.47-3.92, I 2 = 98%, seven studies). Conclusions:Our meta-analysis demonstrated that diverticular disease was associated with colorectal adenomas. Colonoscopists should be aware of this association and carefully examine the entire large bowel in individuals with diverticulosis.

The relationship between diverticulosis and colorectal neoplasia: A meta-analysis

“…However, a recent meta-analysis by Jaruvongvanich et al offered conflicting results. They found a 1.36-fold increased risk of CRC in patients with diverticulosis, although the finding did not reach statistical significance [51]. The discrepant results might be explained by the different modalities used to document diverticulosis.…”

“…In contrast, our data revealed that patients with diverticulosis had a 1.47-fold risk of colorectal adenomas and a 1.95-fold increased risk of polyps compared to controls without diverticulosis. Indeed, many studies reported a positive correlation between diverticulosis and adenomas [10, 13, 17, 32, 44, 51] and some authors have suggested that diverticulosis might be a risk factor for premalignant colorectal lesions, and that endoscopists performing a colonoscopy for a patient with diverticulosis should be aware of possible risk [10, 13]. However, when we performed subgroup analysis based on the indication for colonoscopy, an increased risk of adenomas and polyps was only found in patients who underwent colonoscopy because of their gastrointestinal symptoms and this trend was also reproduced in multivariate analysis.…”

Prediction of the course of diverticular disease in its combination with adenomatous polyps and colorectal cancer in the context of clinical and instrumental data and expression of Ki-67 and α-SMA in the intestinal mucosa

“…ПрОгНОзирОВаНиЕ Настораживает факт повышения частоты встречаемости колоректального рака (Крр) у больных с ДБтК, при том, что оба заболевания имеют общие эпидемиологические тенденции и определенные факторы риска, включая преклонный возраст, физическую инертность, западное питание и образ жизни [4]. Проведенный метаанализ по базам данных MEDLINE и EMBASE с момента их формирования по 2016 год продемонстрировал, что ДБтК ассоциирована с аденоматозными полипами (аПК) и Крр [5]. так, по данным ряда исследований, у 30 % больных с ДБтК одновременно имеются полипы толстой кишки и у 9 % с данной патологией -Крр [6].…”

“…Выявленное в нашем исследовании частое сочетание иБС и Крр находит подтверждение и в литературе. Статистические данные свидетельствуют о том, что иБС и Крр относятся к пяти наиболее часто встречаемым заболеваниям в пожилом возрасте и их нередкое сочетание не менее чем в 26 % случаев является результатом не только возрастных и генетических изменений, но и ряда общих экологических факторов [5].…”

Risk of colorectal neoplasia in patients with colonic diverticula

“…I read with interest the paper by Jaruvongvanich et al . published in the online issue of the Journal.…”