Is routine colonoscopy necessary for patients who have an unequivocal computerised tomography diagnosis of acute diverticulitis?

Abstract

Aims To assess the incidence of underlying colorectal malignancy in patients admitted as an emergency with a CT diagnosis of acute diverticulitis and determine the need for routine follow up colonoscopy Methods A retrospective study was performed on all patients who had been admitted to our surgical unit with CT diagnosed diverticulitis from September 2016 to September 2018 (n = 125). Results 11 patients (8.8%) required emergency resection with no underlying malignancy found. 76 patients (61%) had a follow up colonoscopy after being discharged. 4 patients were found to have an underlying colorectal malignancy, one of them suspected on CT and another an incidentally detected caecal polyp cancer. Therefore 3/87(3.4%) had an unexpected cancer diagnosis and all those in the diseased segment were within complicated diverticulitis. Conclusion Nowadays, multi-slice CT scanners are so good at giving an accurate assessment of colonic pathology. In our study, 96.6% of the patients with a CT diagnosis of acute diverticulitis had no underlying malignancy in the diseased segment with all the cancers within complicated diverticulitis. With such a low yield of underlying malignancy in uncomplicated diverticulitis, we question the need for routine follow up colonoscopy when there is no CT suspicion of malignancy in these patients

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

“…A total of 68 studies with 13 905 patients were included 6,24–90 . There were four prospective studies and one retrospective review of a prospective study 44,60,61,77,89 .…”

“…There were 13 296 patients from 65 studies who underwent a follow up colonoscopy 6,24–42,44–65,67–79,81–90 . The remaining three studies (231 patients) reported follow up with either a colonoscopy or flexible sigmoidoscopy and did not differentiate between the two 43,66,80 .…”

“…Colorectal cancers were identified in 2.0% (95% CI 1.67–2.40) of patients undergoing interval colonoscopy or flexible sigmoidoscopy after acute diverticulitis in 68 studies (see Table 1). 6,24–90 The distribution of cancers was 27.9% sigmoid/descending colon, 9.0% proximal to splenic flexure, 3.7% in rectum and 59.4% with location not reported.…”

“…Location of cancer relative to the area of diverticulitis on CT was reported in 6480 patients from 27 studies. [32][33][34]37,40,41,44,[46][47][48][49]56,59,60,[62][63][64]69,70,73,[77][78][79][80]83,85,90 Cancer was concordant to the area of diverticulitis in 85% and discordant in 15%.…”

Resurgence of Covid-19 pandemic: Challenging situation of economics vs. healthcare

“…Although, we continue to publish articles on Covid-9 pandemic, 6 there is urgent need for us to establish a balance of continuity with publication of non-covid urgent research. Whether that is related to diagnostic test 7,8 or basic research aimed at understanding molecular aspects of drug action 9 or novel innovation in treatment. 10 All that is responsibility of any peerreviewed multidisciplinary journal such as SMJ.…”