Colonoscopy Following Nonoperative Management of Uncomplicated Diverticulitis May Not Be Warranted

Brar, Mantaj S.; Roxin, George; Yaffe, Paul B.; Stanger, Jennifer; MacLean, Anthony R.; Buie, W. Donald

doi:10.1097/dcr.0b013e3182a26bfd

Cited by 64 publications

(70 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…From the patients scoped after the acute episode, 4 patients (2.5%) had colorectal cancer (CRC) and any of them had a previous colonoscopy. Curiously, all patients in whom CRC was diagnosed had uncomplicated disease, which is the opposite of what was found in other studies in which the risk of advanced neoplasia was higher only in those with complicated disease [4,6,7]. In our study, no immediate or late complications related to the colonoscopy were reported.…”

contrasting

confidence: 53%

Acute Diverticulitis and Subsequent Colonoscopy: Instigating an Old Discussion

Gonçalves¹,

Barbosa²,

Marinho³

et al. 2017

Dig Surg

View full text Add to dashboard Cite

contrasting

confidence: 53%

Acute Diverticulitis and Subsequent Colonoscopy: Instigating an Old Discussion

Gonçalves¹,

Barbosa²,

Marinho³

et al. 2017

Dig Surg

View full text Add to dashboard Cite

“…Similarly, Brar et al [41] also found that patients with complicated diverticulitis had a significantly higher incidence of AA (18.9 vs. 5%, p = 0.001) and invasive malignancy (5.4 vs. 0%, p = 0.007) compared to patients who presented with uncomplicated diverticulitis.…”

Section: Discussionmentioning

confidence: 93%

Routine Colonoscopy after Acute Uncomplicated Diverticulitis - Challenging a Putative Indication

Andrade

Ribeiro²,

Ramalho³

et al. 2016

Dig Surg

View full text Add to dashboard Cite

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.

show abstract

“…13,22 It is also not clear whether all the CT scans in the included studies were 64-slice high-resolution scans, as used in our study, which may affect the ability to distinguish malignancy from inflammatory changes. Brar and colleagues 23 reported an overall prevalence of malignancy in CT-scan diagnosed diverticulitis of 1.6%, but complicated diverticulitis with pericolic or pelvic abscess was associated with a higher rate of invasive malignancy: 5.4%. Although our study did not distinguish between complicated and uncomplicated diverticulitis by examining specific radiological features, our results are in line with those of the aforementioned study.…”

Section: Discussionmentioning

confidence: 99%

Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary?

Rosenfeld

Brown

et al. 2015

cjs

View full text Add to dashboard Cite

Background: Computed tomography (CT) scans are commonly used to diagnose acute diverticulitis, but there are overlapping features between diverticulitis and colorectal cancer (CRC) on imaging studies. Hence, colonoscopy is typically recommended after an episode of acute diverticulitis to rule out underlying malignancy. Currently, 64-slice multidetector CT scanners are capable of providing higher-resolution images and may be able to distinguish malignancy from diverticular inflammation. We aimed to determine the prevalence of CRC among patients with CT-diagnosed acute diverticulitis. Methods:We performed a retrospective study of patients with acute diverticulitis diagnosed on CT scan between December 2005 and December 2010 at St. Paul's Hospital, Vancouver, BC. Nonresidents were excluded. We reviewed CT scan reports that included the term "diverticulitis," reports of follow-up colonic evaluation within 1 year of diagnosis and pathology results. We queried the provincial cancer registry to ensure no cases of CRC were missed.Results: A total of 293 patients had acute diverticulitis diagnosed on CT scan, but 8 were nonresidents and were excluded. Of the 285 included in the analysis, the mean age was 59.4 ± 15.1 years, and 167 (58.6%) were men. Among the 114 patients who underwent follow-up evaluation, malignancy was diagnosed in 4 (3.5%). The overall prevalence of malignancy among patients with CT-diagnosed diverticulitis was 1.4%. Conclusion:Routine endoscopic evaluation after an episode of diverticulitis diagnosed with high-resolution CT scan does not appear to be necessary. Selective approach in patients with protracted clinical course or those with mass lesion/ obstruction on CT scan may be of benefit.Contexte : La tomodensitométrie (TDM) est couramment utilisée pour le diagnostic de la diverticulite aiguë, mais des caractéristiques sont communes à la diverticulite et au cancer colorectal (CCR) aux épreuves d'imagerie. On recommande donc en général la coloscopie après un épisode de diverticulite aiguë pour écarter un diagnostic de cancer sous-jacent. À l'heure actuelle, les appareils de TDM multidétecteurs à 64 barrettes peuvent fournir des images de haute résolution et permettent même de distinguer le cancer d'une inflammation diverticulaire. Nous avons voulu déterminer la prévalence du CCR chez les patients ayant présenté une diverticulite aiguë diagnostiquée par TDM. Résultats : En tout, 293 patients ont reçu un diagnostic de diverticulite à l'aide de la TDM; 8 étaient des non-résidents et ont été exclus. Parmi les 285 patients inclus dans l'analyse, l'âge moyen était de 59,4 ± 15,1 ans et 167 (58,6 %) étaient des hommes. Parmi les 114 patients qui ont subi un examen de suivi, le cancer a été diagnostiqué chez 4 (3,5 %). La prévalence globale du cancer chez les patients porteurs d'un diagnostic de diverticulite posé par TDM était de 1,4 %. Conclusion :L'évaluation endoscopique de routine après un épisode de diverticulite diagnostiquée à l'aide d'une TDM de haute résolution ne semble pas nécessaire. Une approc...

show abstract

Colonoscopy Following Nonoperative Management of Uncomplicated Diverticulitis May Not Be Warranted

Cited by 64 publications

References 16 publications

Acute Diverticulitis and Subsequent Colonoscopy: Instigating an Old Discussion

Acute Diverticulitis and Subsequent Colonoscopy: Instigating an Old Discussion

Routine Colonoscopy after Acute Uncomplicated Diverticulitis - Challenging a Putative Indication

Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary?

Contact Info

Product

Resources

About