Routine lower gastrointestinal endoscopy for radiographically confirmed acute diverticulitis. In whom and when is it indicated?

Urgorri, Agustín Seoane; Zaffalon, Diana; Román, Miguel Pera; García, Marc Batlle; Pons, Fausto Riu; Cuscó, Josep Maria Dedeu; Sánchez, Miguel Pantaleón; Caserras, X. Bessa; Priego, Luis Barranco; Álvarez-González, Marco A.

doi:10.17235/reed.2018.5524/2018

Cited by 6 publications

(14 citation statements)

References 21 publications

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“…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].…”

Section: Discussionmentioning

confidence: 99%

“…Colonic diverticular disease is a pathology with a high prevalence throughout the world, being most prevalent in developed countries, and whose incidence is increasing. It is estimated that 5-10% of the population >45 years old and approximately 80% of those >85 years old suffer this pathology [1-4]. The economic impact due to episodes of acute diverticulitis (AD) has been estimated at approximately $3,500-12,800 for each patient admitted, depending on the length of stay and the type of treatment performed [5].…”

Section: Introductionmentioning

confidence: 99%

“…Its pathogenesis is still not fully known, but could be related to changes in the structure and resistance of the colonic wall, due to alterations in intestinal motility or diets lacking in fiber, which cause herniation of the mucosa and submucosa leading to diverticula formation [1]. Most patients with this pathology are asymptomatic, but approximately 25% of them may suffer an episode of AD, which can be complicated by the formation of abscesses, fistulas or colonic perforation [2,4].…”

Section: Introductionmentioning

confidence: 99%

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

Díaz¹

2019

aog

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Background Diverticular disease of the colon has a high global prevalence. The guidelines suggest performing a colonoscopy 4-6 weeks after the acute episode to exclude colorectal cancer (CRC). However, these recommendations are based on old studies, when computed tomography was not used to diagnose acute diverticulitis (AD). There are currently some studies showing that CRC incidence is low in uncomplicated AD (UAD). Therefore, we decided to perform this study to determine the CRC incidence after an AD episode and the diagnostic efficacy of colonoscopy in these patients. Method This was a retrospective cohort study that included patients with AD between July 2016 and December 2017. Results One hundred seventy-four patients had AD. Of these, 46 patients were excluded and we analyzed 128 patients, 72 (56.3%) women and 56 (43.7%) men. Ninety (70.3%) had UAD and 38 (29.7%) complicated AD (CAD). The colonoscopy showed lesions in 18 (14.06%), 5 (3.9%) being CRC. The patients with CRC had shown CAD and were >70 years old (P=0.0001 and P=0.002 respectively). Conclusions Routine colonoscopy in patients with UAD appears not have many benefits as a diagnostic tool. However, it has a higher efficacy if the patients have CAD and are >70 years old.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Díaz¹

2019

aog

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“…25,30,35,49,50,59,60,62,63,78,85,89 There were 13 296 patients from 65 studies who underwent a follow up colonoscopy. 6,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][67][68][69][70][71][72][73][74][75][76][77][78][79][81][82][83][84][85][86][87][88]…”

Section: Study Demographicsmentioning

confidence: 99%

“…6,25,40,41,44,49,58,63,65,78 Follow up was greater than 80% in 25 studies. 25,29,[31][32][33]39,41,44,45,49,[53][54][55]60,61,63,67,71,74,[77][78][79][80]86,89 Primary study outcomes Colorectal cancers were identified in 2.0% (95% CI 1.67-2.40) of patients undergoing interval colonoscopy or flexible sigmoidoscopy after acute diverticulitis in 68 studies (see Table 1). 6, The distribution of cancers was 27.9% sigmoid/descending colon, 9.0% proximal to splenic flexure, 3.7% in rectum and 59.4% with location not reported.…”

Section: Study Demographicsmentioning

confidence: 99%

Endoscopic findings after CT proven acute diverticulitis: a systematic review and meta‐analysis

Cao

Lam

Rickard

2022

ANZ Journal of Surgery

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Background Traditionally, international guidelines recommend patients with acute diverticulitis should be followed up with a colonoscopy 6–8 weeks after discharge. However, the need for an interval colonoscopy has been increasingly challenged in the setting of computed tomography (CT). Previous meta‐analyses have included studies which combined suspected rather than imaging confirmed diverticulitis and often without correlation with endoscopic findings. This meta‐analysis aims to investigate endoscopic findings of patients with CT confirmed diverticulitis. Methods An electronic search of Medline, PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus, Clinicaltrials.gov and WHO ICTRP was performed up to October 18, 2021. Studies which reported CT confirmed acute diverticulitis in adults and who underwent endoscopic follow‐up with either a colonoscopy or flexible sigmoidoscopy were included. Studies were excluded if diverticulitis was diagnosed by clinical grounds alone, ultrasound, barium enema, or other non‐CT forms of imaging. Results A total of 68 studies with 13 905 patients were included. Median age was 58 years and male to female ratio was 0.84. Cancer was detected in 2.0% and advanced adenoma in 3.8%. Complicated diverticulitis had 9.2 higher odds of cancer compared to uncomplicated diverticulitis (95% CI 4.42–19.08, P < 0.001). Adenomas were detected in 17%. Of those diagnosed with colorectal cancer, 85% were concordant with the site of the diverticulitis on CT while 15% were incidental findings. Conclusion Routine colonoscopic follow up should be recommended in medically fit patients who have CT proven acute diverticulitis due to the higher than population prevalence of colorectal cancer and advanced adenomas.

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Pharmacovigilance analysis of orlistat adverse events based on the FDA adverse event reporting system (FAERS) database

Zhu,

Hu,

Liang

et al. 2024

Heliyon

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Routine lower gastrointestinal endoscopy for radiographically confirmed acute diverticulitis. In whom and when is it indicated?

Cited by 6 publications

References 21 publications

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

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

Endoscopic findings after CT proven acute diverticulitis: a systematic review and meta‐analysis

Pharmacovigilance analysis of orlistat adverse events based on the FDA adverse event reporting system (FAERS) database

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