Patients with computed tomography-proven acute diverticulitis require follow-up to exclude colorectal cancer

Abstract

Background/AimsTraditionally, patients with acute diverticulitis undergo follow-up endoscopy to exclude colorectal cancer (CRC). However, its usefulness has been debated in this era of high-resolution computed tomography (CT) diagnosis. We assessed the frequency and outcome of endoscopic follow-up for patients with CT-proven acute diverticulitis, according to the confidence in the CT diagnosis.MethodsRecords of patients with CT-proven acute diverticulitis between October 2007 and March 2014 at Sandwell & West Birmingham Hospitals NHS Trust were retrieved. The National Cancer Registry confirmed the cases of CRC. Endoscopy quality indicators were compared between these patients and other patients undergoing the same endoscopic examination over the same period.ResultsWe identified 235 patients with CT-proven acute diverticulitis, of which, 187 were managed conservatively. The CT report was confident of the diagnosis of acute diverticulitis in 75% cases. Five of the 235 patients were subsequently diagnosed with CRC (2.1%). Three cases of CRC were detected in the 187 patients managed conservatively (1.6%). Forty-eight percent of the conservatively managed patients underwent follow-up endoscopy; one case of CRC was identified. Endoscopies were often incomplete and caused more discomfort for patients with diverticulitis compared with controls.ConclusionsCRC was diagnosed in patients with CT-proven diverticulitis at a higher rate than in screened asymptomatic populations, necessitating follow-up. CT reports contained statements regarding diagnostic uncertainty in 25% cases, associated with an increased risk of CRC. Follow-up endoscopy in patients with CT-proven diverticulitis is associated with increased discomfort and high rates of incompletion. The use of other follow-up modalities should be considered.

Meta-analysis of the role of colonoscopy after an episode of left-sided acute diverticulitis

“…All studies were published after 2003. There were four prospective cohort studies and 13 retrospective cohort studies ( Table ). Four studies included only patients with left‐sided acute diverticulitis, and only the subgroup of patients with left‐sided diverticulitis from one Korean study was included in the present review.…”

“…Four studies included only patients with left‐sided acute diverticulitis, and only the subgroup of patients with left‐sided diverticulitis from one Korean study was included in the present review. Twelve studies did not report the proportion of left‐sided diverticulitis, but were conducted in the West. Most studies included all patients with acute diverticulitis; two included only patients with uncomplicated diverticulitis.…”

“…Eight studies excluded patients who underwent colonoscopy before (varying from 6 months to 2 years) the diagnosis of acute diverticulitis. Colorectal carcinoma was reported in all 17 studies. Eight studies used the correct definition of advanced adenoma and could therefore be used for analysis of ACN (colorectal carcinoma and advanced adenoma combined).…”

“…Ten studies, including 43 patients with colorectal carcinoma, reported the location of the carcinoma. Almost all tumours (41 of 43) were found at the site of the presumed acute diverticulitis.…”

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