Follow up colonoscopy may be omissible in uncomplicated left-sided acute diverticulitis diagnosed with CT- a retrospective cohort study

Abstract

International guidelines recommend colonoscopy following hospitalisation for acute diverticulitis. There is a paucity of evidence supporting the efficacy of colonoscopy in this context, particularly for patients with CT-diagnosed uncomplicated left-sided diverticulitis. This study aims to investigate the frequency that colorectal cancer (CRC) and advanced adenomas (AA) are identified during follow-up colonoscopy after hospitalisation with CT-proven left-sided diverticulitis for the first time in a UK population. In this single-centre retrospective-cohort study all patients presenting with CT-diagnosed uncomplicated left-sided diverticulitis between 2014 and 2017 were identified. The incidence of histologically confirmed CRC and AA identified at follow-up colonoscopy 4–6 weeks following discharge was assessed. 204 patients with CT proven uncomplicated left-sided diverticulitis underwent follow-up colonoscopy. 72% were female and the median age was 63 years. There were no major complications. 22% of patients were found to have incidental hyperplastic polyps or adenomas with low-grade dysplasia. No CRC or AA were found. Routine colonoscopy following acute diverticulitis in this cohort did not identify a single CRC or AA and could arguably have been omitted. This would significantly reduce cost and pressure on endoscopy departments, in addition to the pain and discomfort that is commonly associated with colonoscopy.

Routine Endoscopy After Acute Sigmoid Diverticulitis: Would a Sigmoidoscopy be Sufficient?

“…While the potentially devastating outcome of missing an underlying malignancy may be what has caused hesitancy to change practice regarding the utilisation of endoscopy following acute sigmoid diverticulitis, colonoscopy as a procedure is not without risk. One in 2500 colonoscopies result in perforation and 1 in 2000 patients suffer bleeding requiring intervention [ 15 ]. Diverticular disease is a recognized risk factor for colonoscopic perforation, meaning this patient’s demographic is at particular risk of complication from a procedure which may be difficult to justify based on the available evidence [ 16 ].…”

“…Diverticular disease is also a risk factor for challenging colonoscopy, reflected by an association with poor completion rates, significant patient discomfort, and prolonged procedure duration [ 16 ]. Colonoscopy is costly for the health service, with an estimated cost of €530 per procedure, and requires approximately 30 min per procedure [ 15 ]. The bowel preparation necessary for a full colonoscopy can result in significant morbidity and potentially mortality as a result of renal impairment and electrolyte imbalance, and adverse events as a result of sedation and opioid-based analgesia are well recognized [ 11 ].…”

Endoscopic findings after CT proven acute diverticulitis: a systematic review and meta‐analysis

“…25,30,35,49,50,59,60,62,63,78,85,89 There were 13 296 patients from 65 studies who underwent a follow up colonoscopy. 6,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][67][68][69][70][71][72][73][74][75][76][77][78][79][81][82][83][84][85][86][87][88]…”

Management of Colonic Diverticulitis

“…Three of these compared colonoscopy to no colonoscopy in patients with recent diverticulitis, 103-105 three compared colonoscopy in patients with recent diverticulitis to healthy controls, 106-108 one compared early (in-hospital) colonoscopy to later colonoscopy, 109 and 13 were single-group studies of patients who underwent colonoscopy. [110][111][112][113][114][115][116][117][118][119][120][121][122] Appendix C Tables C-3-1 to C-3-4 give descriptions of the studies; results are in Appendix D Tables D-3-1 to D-3-7. An additional study of interest that did not meet eligibility criteria is also discussed together with the comparative studies.…”

“…We identified 13 single group studies, all retrospective, that evaluated colonoscopy outcomes. [110][111][112][113][114][115][116][117][118][119][120][121][122] The 13 studies were each conducted at a single center and all patients received followup colonoscopy after treatment of acute diverticulitis treatment. The mean age of participants across studies ranged from 41 to 64 years old.…”