Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4,241 colonoscopies

Abstract

Background and aims There are conflicting data concerning the association between diverticular disease and colorectal carcinoma (CRC). This study was performed to determine the prevalence and association of diverticulosis, diverticulitis, polyps, and CRC. Materials and methods In a cross-sectional, retrospective study, we analyzed the colonoscopy reports of complete colonoscopies and patho-histological results of all patients referred for colonoscopy in a period of 3 months in 18 hospitals in The Netherlands. Diverticulosis was defined as three or more diverticula present and diverticulitis as diverticulosis with inflammation. Polyps were also coded according to localization and size. Advanced neoplastic lesions were defined as polyps ≥10 mm in diameter and/or villous architecture and/or adenomas with high grade dysplasia and/or invasive cancer. Actual and previous described CRC were registered. Results A total of 4,241 patients were included in the study [1,996 (47%) male], mean age of 59 and range 18-95. Diverticula, diverticulitis, and polyps were seen in 1,052 (25%), 75 (2%), and 1,282 (30%) patients, respectively. No association was found between patients with polyps and those with and without diverticulosis (p=0.478). Invasive adenocarcinoma and adenomas ≥10 mm were most frequently observed. CRC was present in 372 (9%) patients. Negative relation between diverticulosis and CRC and invasive adenocarcinoma was observed. No association was found between polyps and CRC and patients with diverticulitis and CRC. In conclusion, there is no relation between patients with diverticulosis and higher incidence of polyps or CRC when using age-stratified analysis. No increased risk for polyps or CRC was found in patients with diverticulitis.

Colonic diverticulosis is associated with an increased adenoma detection rate in patients undergoing first-time screening colonoscopy

“…There have been a handful of conflicting, heterogeneous clinical reports published over the past two decades that explore the possibility of a relationship between colonic diverticular disease and colorectal polyps or cancer. [13][14][15][16][17] Our study found on adjusted multivariate analysis a statistically significant association between colonic diverticulosis and the colorectal ADR in patients undergoing a first-time colonoscopy for colorectal cancer screening. When patients with a reported first-degree family history of colorectal cancer or colorectal polyps (presumed to be adenomas) were excluded in order to isolate only "average-risk" patients, further decreasing the sample size, adjusted multivariate analysis still demonstrated a trend towards an association between diverticulosis and an increased ADR.…”

“…Hirata et al 14 found in a retrospective review of Japanese patients undergoing total colonoscopy after hemorrhoidectomy for rectal bleeding that on multivariate logistic regression analysis adjusted for age and sex there was a statistically significant association between diverticulosis in any portion of the colon and colon polyps in all locations (OR 1.7, 95% CI: 1.1 to 2.5, p=0.01). In contrast to these studies, MeursSzojda et al 16 found in 4,241 patients that there was no relation between patients with diverticulosis and a higher incidence of polyps or CRC when using an age-stratified analysis (p=0.478).…”

“…12 Despite this apparent commonality with advancing age, it is not clear if there is an association between colonic diverticulosis and colorectal neoplasia, as only a few conflicting studies have been published. [13][14][15][16][17] Furthermore, those prior studies did not examine the relationship between diverticulosis and the ADR in patients undergoing first-time screening colonoscopy. Lastly, possible associations between diverticulosis and other indicators of colonoscopic quality (ie, cecal intubation rates, scope insertion and withdrawal times, and sedation requirements) have not been described.…”

Contemporary Review of Risk‐Stratified Management in Acute Uncomplicated and Complicated Diverticulitis

“…[39] The yield of advanced colonic neoplasia during colonoscopy after acute diverticulitis is equivalent to that detected in asymptomatic average-risk screening participants. A systematic review has found an estimated pooled prevalence of 5.0% (CI; 3.8-6.7%) for advanced colonic neoplasia and 1.5% (CI; 1.0-2.3%) for CRC at follow-up after an episode of CT confirmed acute diverticulitis.…”

Diverticular disease and cancer: an unproven link

“…[8] A study on more than 4200 colonoscopies did not find an association between polyps and diverticulosis and diverticulitis and actually there was a negative correlation between cancer and diverticulosis. [9] A risk of extracolonic malignancy lying within the abdomen and pelvis has been previously reported in patients with a diagnosis of diverticulosis or diverticulitis. [10] Diverticulitis is known to be a pericolonic inflammation, pericolonic abscesses and phlegmon masses are certain to cause peritoneal inflammation.…”