Yield of Post-acute Diverticulitis Colonoscopy for Ruling out Colorectal Cancer

Azizian, John; Trieu, Harry; Kovacs, Thomas O.; Turkiewicz, Joanna; Hilder, Robin; Palmer, Samantha; Roux, Michelle Le; Dong, Tien S.; Berry, Rani; Beaven, Simon W.; Tabibian, James H.

doi:10.1016/j.tige.2022.04.001

Cited by 4 publications

(4 citation statements)

References 28 publications

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“…Conversely, many studies cited a higher AA rate in complicated AD compared to uncomplicated AD and to normal population (8). A histological analysis of polyps in AD detected in this study revealed just over 3% to be AA, not far off from various recent literature reporting this to range from 3.9 -10.6% in AD (4,8,10,23), and not significantly different to incidence of AA in normal population ranging from 3.28 -7.7% (10,28). The data also highlighted an obvious, though statistically not significant, trend towards higher sessile serrated adenomata in complicated versus uncomplicated AD (n = 6 vs 1), in keeping with similar research as above.…”

Section: Discussion Discussionmentioning

confidence: 97%

“…Other studies demonstrated equal rates in the uncomplicated AD subset and the normal population (10,22). Conversely, many studies cited a higher AA rate in complicated AD compared to uncomplicated AD and to normal population (8). A histological analysis of polyps in AD detected in this study revealed just over 3% to be AA, not far off from various recent literature reporting this to range from 3.9 -10.6% in AD (4,8,10,23), and not significantly different to incidence of AA in normal population ranging from 3.28 -7.7% (10,28).…”

Section: Discussion Discussionmentioning

confidence: 99%

“…These signs include the presence or absence of free gas, abscess formation, fistula, obstruction, stricture, and irregular bowel wall thickening. Using these criteria, the proportion of patients considered high risk may range between 7-38% (8,9). Perhaps the vast reduction in patients recommended for Colonoscopy, and the risk of even a low number of patients that could have a missed cancer has resulted in the lack of firm guidelines.…”

Section: Introduction Introductionmentioning

confidence: 99%

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Practical Decision-Making in Regards to Colonoscopy following Admission for Acute Diverticulitis

Masood,

Tacey,

Strugnell

et al. 2023

SGO

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Objective: Patients with acute diverticulitis (AD) have an increased risk of underlying colorectal cancer (CRC), however those with uncomplicated AD may have the same underlying population risk. Despite evidence suggesting these patients may not require further endoscopy, published guidelines still recommended Colonoscopy as standard postdiverticulitis management. A practical approach to the definition of bowel wall thickening may improve negative predictability, a potential impediment to omitting colonoscopic followup. Material and Methods: A 2-year (July 2016 -June 2018) retrospective study of patients admitted with CT confirmed acute diverticulitis was conducted. CT findings were categorised as 'complicated' or 'uncomplicated' and were correlated with the detection of cancer in subsequent Colonoscopy or follow-up. Bowel thickening was defined as any bowel thickening reported as such by the reporting Radiologist. Results: Of a total of 431 patients, 67.7% (n=292) were seen to have had complicated AD on CT with complication features of bowel wall thickening (61.2%), perforation (13.7%), or an abscess (8.1%). Follow-up colonoscopic evaluation was conducted in 52.9% (n=228) of total cases of AD. Six patients were found to have colorectal cancer on Colonoscopy, all in complicated group although this was not statistically significant (p=0.18). Polyp detection rates were similar between groups. Radiologist-reported bowel wall thickening was a feature of all malignant diagnoses, and the only feature in 3 of the 6 patients. Conclusion:The only CRC diagnoses were made in patients with complicated AD. There may be scope to safely decrease the number of Colonoscopies performed in AD patients and the use of Radiologist-reported bowel wall thickening may a practical improvement to local definitions of complicated diverticulitis.

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Section: Discussion Discussionmentioning

confidence: 97%

Section: Discussion Discussionmentioning

confidence: 99%

Section: Introduction Introductionmentioning

confidence: 99%

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Practical Decision-Making in Regards to Colonoscopy following Admission for Acute Diverticulitis

Masood,

Tacey,

Strugnell

et al. 2023

SGO

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“…The reported incidence of colonic neoplasia varied signi cantly between different studies. Multiple meta-analysis and systematic reviews reported the rate of associated colonic malignancy between 0.25% and 0.78% in uncomplicated diverticulitis and 7.8-10.9% in complicated diverticulitis [14][15][16][17][18][19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Analysis of the outcomes of post-diverticulitis investigations, A multicentre cohort study including 1052 patients

Abdelrahim,

Ali,

Kamali

et al. 2024

Preprint

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Aim: This is the largest single study, to date, which aims to assess the yield of the endoscopic investigations performed following acute diverticulitis. Method: A retrospective multi-centre study included patients with multislice computed tomography (MSCT) proven diverticulitis, in three NHS hospitals, between January 2016 and December 2022. The primary outcome was the rate of colonic cancer in the diseased segment. Secondary outcomes included the rate of malignancy in the non-diseased colonic segments, the benign colonic polyp detection rate, the rate of malignancy in the resected surgical specimens in patients who underwent an emergency surgery on the index admission and the rate of complications in the investigated group. Results: 1052 patients were included in the study; out of which 680 (64.6%) were females with median age of 65 (21-91) years. 694 patients (66%) had uncomplicated diverticulitis (Hinchey stage 1A) while 358 (39%) had complicated diverticulitis (Hinchey stage 1B - 4). Following the acute episode, 715 (68%) patients had subsequent endoscopic evaluation. The incidence of colorectal cancer (CRC) or advanced adenomas (AA) in patients with uncomplicated (Hinchey 1A) diverticulitis was 0.14%. The incidence of CRC/AA in patients with Hinchey 1b and Hinchey 2 was 1.4 % and 4.4% respectively. 18/98 patients (18.4%) out of the patients who underwent emergency colonic resection for suspected perforated diverticulitis had histological evidence of colonic malignancy. Conclusion: Colonoscopy following uncomplicated diverticulitis has a low yield. It should be reserved for patients with complicated diverticulitis and those with uncomplicated diverticulitis who have suspicious radiological or clinical manifestations. In patients who undergo emergency surgery, oncological principles should be applied whenever possible.

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Follow-Up Colonoscopy for Detection of Missed Colorectal Cancer After Diverticulitis

Redd,

Holub,

Nichols

et al. 2024

Clinical Gastroenterology and Hepatology

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Yield of Post-acute Diverticulitis Colonoscopy for Ruling out Colorectal Cancer

Cited by 4 publications

References 28 publications

Practical Decision-Making in Regards to Colonoscopy following Admission for Acute Diverticulitis

Practical Decision-Making in Regards to Colonoscopy following Admission for Acute Diverticulitis

Analysis of the outcomes of post-diverticulitis investigations, A multicentre cohort study including 1052 patients

Follow-Up Colonoscopy for Detection of Missed Colorectal Cancer After Diverticulitis

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