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

Hannan, Enda; Harding, Tim; Duggan, William; Brosnan, Conor; Maguire, Donal

doi:10.7759/cureus.17648

Cited by 2 publications

(11 citation statements)

References 16 publications

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“…The high frequency of colonoscopy in our series (20% of post discharge-endoscopy) is also of interest. Given that only 6% of disease was proximal to the left colon, it is perhaps surprising that more patients were not offered a flexible sigmoidoscopy [ 22 ]. Whether this might improve acceptability and take-up of endoscopy is uncertain.…”

Section: Discussionmentioning

confidence: 99%

Can endoscopic follow-up after acute diverticulitis be rationalised?

et al. 2023

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Background Acute diverticulitis (AD) is a common cause of presentation to emergency surgical services. Follow-up with endoluminal investigation to exclude colorectal cancer (CRC) remains controversial. Guidelines are increasingly moving to a more restrictive follow-up based on severity of disease and age. The purpose of this observational study was to assess the prevalence of CRC in AD patients and the impact of follow-up on endoscopy services. Methods Patients admitted with a diagnosis of AD over a 2-year period were reviewed. The proportion of patients undergoing endoscopic follow-up and the CRC detection rate were recorded. The potential impact of a more conservative approach to follow-up was evaluated. Results There were 484 patients with AD presenting 546 times (M:F = 198:286; median age = 63 years). 80% of admissions were aged 50 or older. There were 43 emergency interventions in 39 patients (10 percutaneous drain; 33 surgery). The remainder were managed conservatively. 28 patients (5.1%) underwent colonic resection with cancer found in one specimen (3.6%). 287 patients underwent endoluminal follow-up with cancer diagnosed in 3 cases (1.0%). There was no significant difference in the prevalence of CRC between patients requiring emergency surgery and those managed conservatively, or between patients with complicated versus uncomplicated diverticulitis. Conclusion CRC masquerading as acute diverticulitis is rare. The incidence of neoplasia both at endoscopic follow-up and in patients requiring emergency intervention is low. Conservative follow-up strategies appear safe, but their effectiveness in reducing the burden on endoscopy services may be limited by current age-based recommendations. Restricting follow-up to those with complicated AD would reduce the number of patients requiring endoluminal investigation by 70%.

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Section: Discussionmentioning

confidence: 99%

Can endoscopic follow-up after acute diverticulitis be rationalised?

et al. 2023

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“…6,25,40,41,44,49,58,63,65,78 Follow up was greater than 80% in 25 studies. 25,29,[31][32][33]39,41,44,45,49,[53][54][55]60,61,63,67,71,74,[77][78][79][80]86,89 Primary study outcomes 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, 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.…”

Section: Study Demographicsmentioning

confidence: 99%

“…Diverticular disease was detected in 87% of follow up endoscopies after CT proven diverticulitis and reported in 3940 patients from 21 studies. 24,32,38,43,44,50,51,53,56,62,64,[69][70][71][72]77,78,80,81,85,88 Non advanced adenomas detection rate was 17.1% (1247/7283) from 46 studies. 6,24,[26][27][28][29][30][31]36,37,[39][40][41][42]44,[47][48][49][50]52,53,55,[57][58][59][60][61][62][63][64]…”

Section: Other Intraluminal Findingsmentioning

confidence: 99%

“…24,32,38,43,44,50,51,53,56,62,64,[69][70][71][72]77,78,80,81,85,88 Non advanced adenomas detection rate was 17.1% (1247/7283) from 46 studies. 6,24,[26][27][28][29][30][31]36,37,[39][40][41][42]44,[47][48][49][50]52,53,55,[57][58][59][60][61][62][63][64][65][67]…”

Section: Other Intraluminal Findingsmentioning

confidence: 99%

“…6,24,[26][27][28][29][30][31]36,37,[39][40][41][42]44,[47][48][49][50]52,53,55,[57][58][59][60][61][62][63][64][65][67][68][69][70][71]73,74,77,[79][80][81][82]85,87,88 Hyperplastic polyps were detected in 9.7% (475/4868) of patients from 26 studies. [27][28][29][30][31]42,44,...…”

Section: Other Intraluminal Findingsmentioning

confidence: 99%

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

Cao

Lam

Rickard

2022

ANZ Journal of Surgery

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Background Traditionally, international guidelines recommend patients with acute diverticulitis should be followed up with a colonoscopy 6–8 weeks after discharge. However, the need for an interval colonoscopy has been increasingly challenged in the setting of computed tomography (CT). Previous meta‐analyses have included studies which combined suspected rather than imaging confirmed diverticulitis and often without correlation with endoscopic findings. This meta‐analysis aims to investigate endoscopic findings of patients with CT confirmed diverticulitis. Methods An electronic search of Medline, PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus, Clinicaltrials.gov and WHO ICTRP was performed up to October 18, 2021. Studies which reported CT confirmed acute diverticulitis in adults and who underwent endoscopic follow‐up with either a colonoscopy or flexible sigmoidoscopy were included. Studies were excluded if diverticulitis was diagnosed by clinical grounds alone, ultrasound, barium enema, or other non‐CT forms of imaging. Results A total of 68 studies with 13 905 patients were included. Median age was 58 years and male to female ratio was 0.84. Cancer was detected in 2.0% and advanced adenoma in 3.8%. Complicated diverticulitis had 9.2 higher odds of cancer compared to uncomplicated diverticulitis (95% CI 4.42–19.08, P < 0.001). Adenomas were detected in 17%. Of those diagnosed with colorectal cancer, 85% were concordant with the site of the diverticulitis on CT while 15% were incidental findings. Conclusion Routine colonoscopic follow up should be recommended in medically fit patients who have CT proven acute diverticulitis due to the higher than population prevalence of colorectal cancer and advanced adenomas.

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

Cited by 2 publications

References 16 publications

Can endoscopic follow-up after acute diverticulitis be rationalised?

Can endoscopic follow-up after acute diverticulitis be rationalised?

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

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