Early Colonoscopy in Patients with Acute Diverticulitis: Results of a Prospective Pilot Study

Sakhnini, Emad; Lahat, Adi; Melzer, Ehud; Apter, Sara; Simon, Charles E.; Natour, Mohammed; Bardan, Eytan; Bar‐Meir, Simon

doi:10.1055/s-2004-814398

Cited by 46 publications

(67 citation statements)

References 2 publications

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“…In our previous publications, we showed the main disadvantage of performing an early colonoscopy during hospitalization is the higher rate of incomplete examinations (18%) [13,14] . However, in this small but important group of patients with a persistent disease course, an early colonoscopy seemed to be beneficial.…”

Section: Discussionmentioning

confidence: 96%

“…Late colonoscopy was defined as when the procedure was performed at least 6 wk after discharge, and when the patient was asymptomatic. The timing of the colonoscopy was based upon randomization protocols, as described in our previous two studies [13,14] .…”

Section: Patientsmentioning

confidence: 99%

“…In two previous studies, we have shown that performing an early colonoscopy during hospitalization for acute diverticulitis is feasible and safe [13,14] . Early inhospital colonoscopy was associated with better patient compliance, but a lower rate of cecal intubation.…”

Section: Introductionmentioning

confidence: 99%

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Role of colonoscopy in patients with persistent acute diverticulitis

Lahat¹,

Yanai²,

Sakhnini³

et al. 2008

WJG

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Section: Discussionmentioning

confidence: 96%

Section: Patientsmentioning

confidence: 99%

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Role of colonoscopy in patients with persistent acute diverticulitis

Lahat¹,

Yanai²,

Sakhnini³

et al. 2008

WJG

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“…This statement is based among other things on a study in 54 patients with diverticulitis in whom colonoscopy resulted in a perforation in 1.9 % of cases. However, in the subgroup of 39 of 54 patients in whom a covered perforation or abscess had been ruled out by CT, not a single perforation was observed [36]. In the specified study, colonoscopy allowed real-time diagnosis of two CT-negative adenocarcinomas among other things.…”

mentioning

confidence: 89%

S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist

Schreyer

Layer

2015

Fortschr Röntgenstr

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Diverticular disease and diverticulitis represent an increasingly common disease especially in patients with advanced age. The German Society of Digestive and Metabolic Diseases (DGVS) as well as the German Society of General and Visceral Surgery (DGAV) in collaboration with the German Radiology Society (DRG) created and published S2k guidelines regarding this topic. Knowledge of the diagnosis and therapy of this common disease is extremely important for the radiologist for the daily clinical routine. In this article we review and discuss the most important clinical situations and algorithms of this disease focusing on radiological topics. Additionally, we introduce the new CCD (classification of diverticular disease) system regarding radiology. Key Points: ??For the diagnosis of a diverticular disease a sectional imaging method should be performed. First choice should be a ?qualified ultrasound examination? followed by CT in uncertain situations or complicated disease. ??Disease classification should be done according the new CCD (Classification of diverticular disease) algorithm. ??Based on this new CCD patients can be stratified into outpatient, in-house patient and surgical treatment therapy. Citation Format: ??Schreyer AG, Layer G. S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist. Fortschr R?ntgenstr 2015; 187: 676???684

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“…Colonoscopy is not recommended in the acute phase to diagnose ACD (level B [71] and level C [72]). Although proven feasible in one prospective study, it is rarely needed in the acute phase (level C).…”

Section: Colonoscopymentioning

confidence: 99%

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Andeweg¹,

Mulder²,

et al. 2013

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Background: The incidence of acute left-sided colonic diverticulitis (ACD) is increasing in the Western world. To improve the quality of patient care, a guideline for diagnosis and treatment of diverticulitis is needed. Methods: A multidisciplinary working group, representing experts of relevant specialties, was involved in the guideline development. A systematic literature search was conducted to collect scientific evidence on epidemiology, classification, diagnostics and treatment of diverticulitis. Literature was assessed using the classification system according to an evidence-based guideline development method, and levels of evidence of the conclusions were assigned to each topic. Final recommendations were given, taking into account the level of evidence of the conclusions and other relevant considerations such as patient preferences, costs and availability of facilities. Results: The natural history of diverticulitis is usually mild and treatment is mostly conservative. Although younger patients have a higher risk of recurrent disease, a higher risk of complications compared to older patients was not found. In general, the clinical diagnosis of ACD is not accurate enough and therefore imaging is indicated. The triad of pain in the lower left abdomen on physical examination, the absence of vomiting and a C-reactive protein >50 mg/l has a high predictive value to diagnose ACD. If this triad is present and there are no signs of complicated disease, patients may be withheld from further imaging. If imaging is indicated, conditional computed tomography, only after a negative or inconclusive ultrasound, gives the best results. There is no indication for routine endoscopic examination after an episode of diverticulitis. There is no evidence for the routine administration of antibiotics in patients with clinically mild uncomplicated diverticulitis. Treatment of pericolic or pelvic abscesses can initially be treated with antibiotic therapy or combined with percutaneous drainage. If this treatment fails, surgical drainage is required. Patients with a perforated ACD resulting in peritonitis should undergo an emergency operation. There is an ongoing debate about the optimal surgical strategy. Conclusion: Scientific evidence is scarce for some aspects of ACD treatment (e.g. natural history of ACD, ACD in special patient groups, prevention of ACD, treatment of uncomplicated ACD and medical treatment of recurrent ACD), leading to treatment being guided by the surgeon's personal preference. Other aspects of the management of patients with ACD have been more thoroughly researched (e.g. imaging techniques, treatment of complicated ACD and elective surgery of ACD). This guideline of the diagnostics and treatment of ACD can be used as a reference for clinicians who treat patients with ACD.

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Early Colonoscopy in Patients with Acute Diverticulitis: Results of a Prospective Pilot Study

Abstract: Early colonoscopy in patients with acute diverticulitis may alter the working diagnosis and be of therapeutic value. The rate of cecal intubation is lower and the perforation rate appears to be higher. A clear-cut indication therefore has to be evident clinically.

Cited by 46 publications

References 2 publications

Role of colonoscopy in patients with persistent acute diverticulitis

Role of colonoscopy in patients with persistent acute diverticulitis

S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

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