Yield of colonoscopy after recent CT-proven uncomplicated acute diverticulitis: a comparative cohort study

Daniels, Lidewine; Ünlü, Çağdaş; Wijkerslooth, Thomas R. de; Stockmann, H. B. A. C.; Kuipers, Ernst J.; Boermeester, Marja A.; Dekker, Evelien

doi:10.1007/s00464-014-3977-9

Cited by 38 publications

(66 citation statements)

References 46 publications

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“…The authors draw similar conclusions compared to our previous study. Follow-up with colonoscopy may be beneficial only for high-risk patients [22]. Several other studies regarding the necessity of diagnostic colonoscopy after proven diverticulitis are in line with our study.…”

Section: Discussionsupporting

confidence: 89%

“…In the case of alarm symptoms, a colonoscopy does appear to be indicated to rule out CRC [8,21]. This is in line with the study of Daniels et al [22] who showed that detection of advanced colonic neoplasia by colonoscopy after CTproven uncomplicated acute diverticulitis is comparable to randomly picked asymptomatic CRC screening participants. The authors draw similar conclusions compared to our previous study.…”

Section: Discussionsupporting

confidence: 80%

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Tumour Characteristics of Patients with Colorectal Cancer after Acute Uncomplicated Diverticulitis

Ramphal

Schreinemakers

Seerden

et al. 2018

Dig Dis

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Background: The association between diverticulitis and colorectal cancer (CRC) remains unclear, though both share epidemiological characteristics. The aim of this study was to investigate whether there is higher risk for CRC after an episode of uncomplicated diverticulitis. Furthermore, in cases of CRC, we sought to determine specific tumour characteristics. Methods: This retrospective observational study includes patients with acute diverticulitis (Hinchey 0 and 1) who were conservatively treated with or without antibiotics between 2008 and 2013. Patients with endoscopic follow-up were included for analysis. Tumour characteristics of patients diagnosed with CRC during colonoscopic follow-up according to patients’ presentation of alarm symptoms were considered to be the primary endpoint. Results: A total of 977 patients were conservatively treated for an episode of acute diverticulitis, 645 of whom underwent colonoscopy during follow-up. Ten patients were diagnosed with CRC, nine of whom exhibited alarm symptoms. One patient was diagnosed with stage I disease, 4 had stage II, and 5 had stage III disease. Conclusions: This study strongly suggests that even though CRC is rare after uncomplicated diverticulitis, in cases of alarm symptoms, a colonoscopy is indicated. In cases where CRC is diagnosed, it is often advanced with a higher TNM stage and poor prognosis.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 80%

Tumour Characteristics of Patients with Colorectal Cancer after Acute Uncomplicated Diverticulitis

Ramphal

Schreinemakers

Seerden

et al. 2018

Dig Dis

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“…Similarly, a study of 80 follow-up endoscopies detected no CRC 8. However, three recent large studies reported higher CRC detection rates of 2.1%,10 4.3%,16 and 2.2% 14. These studies followed up 319, 394, and 402 patients by endoscopy, respectively, the results of which are similar to the overall CRC detection rate in our study.…”

Section: Discussionsupporting

confidence: 89%

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

et al. 2017

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Background/AimsTraditionally, patients with acute diverticulitis undergo follow-up endoscopy to exclude colorectal cancer (CRC). However, its usefulness has been debated in this era of high-resolution computed tomography (CT) diagnosis. We assessed the frequency and outcome of endoscopic follow-up for patients with CT-proven acute diverticulitis, according to the confidence in the CT diagnosis.MethodsRecords of patients with CT-proven acute diverticulitis between October 2007 and March 2014 at Sandwell & West Birmingham Hospitals NHS Trust were retrieved. The National Cancer Registry confirmed the cases of CRC. Endoscopy quality indicators were compared between these patients and other patients undergoing the same endoscopic examination over the same period.ResultsWe identified 235 patients with CT-proven acute diverticulitis, of which, 187 were managed conservatively. The CT report was confident of the diagnosis of acute diverticulitis in 75% cases. Five of the 235 patients were subsequently diagnosed with CRC (2.1%). Three cases of CRC were detected in the 187 patients managed conservatively (1.6%). Forty-eight percent of the conservatively managed patients underwent follow-up endoscopy; one case of CRC was identified. Endoscopies were often incomplete and caused more discomfort for patients with diverticulitis compared with controls.ConclusionsCRC was diagnosed in patients with CT-proven diverticulitis at a higher rate than in screened asymptomatic populations, necessitating follow-up. CT reports contained statements regarding diagnostic uncertainty in 25% cases, associated with an increased risk of CRC. Follow-up endoscopy in patients with CT-proven diverticulitis is associated with increased discomfort and high rates of incompletion. The use of other follow-up modalities should be considered.

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“…The largest study performed included 2,821,392 screening colonoscopies and found a CRC prevalence of 0.9% [32] . Furthermore, recently published literature has shown that the prevalence of AA, ACN, and CCR did not significantly differ between patients with recent uncomplicated diverticulitis and average-risk screening participants [36][37][38][39][40] .…”

Section: Discussionmentioning

confidence: 90%

Routine Colonoscopy after Acute Uncomplicated Diverticulitis - Challenging a Putative Indication

Andrade

Ribeiro²,

Ramalho³

et al. 2016

Dig Surg

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Background and Aims: Most international guidelines recommend performing a routine colonoscopy after the conservative management of acute diverticulitis, mainly to rule out a colorectal malignancy; however, data to support these recommendations are scarce and conflicting. This study is aimed at determining the rate of advanced colonic neoplasia (ACN) found by colonoscopy, and hence the need for routine colonoscopy after CT-diagnosed acute diverticulitis. Methods: We retrospectively analyzed all patients hospitalized for acute diverticulitis between July 2008 and June 2013. Patients who underwent colonoscopy more than 1 year after the acute episode were excluded. Advanced adenoma (AA) was defined as an adenoma with: (i) ≥10 mm, (ii) ≥25% villous features, or (iii) high-grade dysplasia. ACN included cases of colorectal cancer (CRC) and AA. Results: Of the 364 selected patients, 252 (69%) underwent colonoscopy (51% women, median age 55 ± 11 years). Adenomatous polyps were evident in 14.7% patients; 5.1% had AA and 3.2% had CRC. Patients with complicated diverticulitis had a higher number of ACN compared to those with uncomplicated diverticulitis (20.9 vs. 5.7%, p = 0.003). On multivariate analysis, age ≥50 years (OR 8.12, 95% CI 2.463-45.112; p = 0.017) and abscess on CT (OR 3.15, 95% CI 1.586-11.586; p = 0.036) were identified as significant risk factors for ACN. Conclusions: Patients with diverticulitis complicated with abscess have a higher risk of ACN on follow-up colonoscopy. The prevalence of ACN in patients with uncomplicated diverticulitis is quite similar to the average-risk population, and therefore an episode of CT-diagnosed uncomplicated diverticulitis, per se, does not seem to be a recommendation for colonoscopy.

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Yield of colonoscopy after recent CT-proven uncomplicated acute diverticulitis: a comparative cohort study

Cited by 38 publications

References 46 publications

Tumour Characteristics of Patients with Colorectal Cancer after Acute Uncomplicated Diverticulitis

Tumour Characteristics of Patients with Colorectal Cancer after Acute Uncomplicated Diverticulitis

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

Routine Colonoscopy after Acute Uncomplicated Diverticulitis - Challenging a Putative Indication

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