Systematic Review and Meta-analysis of the Role of Routine Colonic Evaluation After Radiologically Confirmed Acute Diverticulitis

Sharma, Prashant; Eglinton, Timothy; Hider, Phil; Frizelle, Frank

doi:10.1097/sla.0000000000000294

Cited by 150 publications

(119 citation statements)

References 28 publications

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“…[18][19][20][21] In these studies, the prevalence of CRC among patients with radiologically diagnosed diverticulitis ranged from 1.0% to 2.1%. However, 3 of these studies excluded patients with complicated diverticulitis and patients who underwent surgical management for their diverticular disease.…”

Section: Discussionmentioning

confidence: 99%

Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary?

Rosenfeld

Brown

et al. 2015

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Background: Computed tomography (CT) scans are commonly used to diagnose acute diverticulitis, but there are overlapping features between diverticulitis and colorectal cancer (CRC) on imaging studies. Hence, colonoscopy is typically recommended after an episode of acute diverticulitis to rule out underlying malignancy. Currently, 64-slice multidetector CT scanners are capable of providing higher-resolution images and may be able to distinguish malignancy from diverticular inflammation. We aimed to determine the prevalence of CRC among patients with CT-diagnosed acute diverticulitis. Methods:We performed a retrospective study of patients with acute diverticulitis diagnosed on CT scan between December 2005 and December 2010 at St. Paul's Hospital, Vancouver, BC. Nonresidents were excluded. We reviewed CT scan reports that included the term "diverticulitis," reports of follow-up colonic evaluation within 1 year of diagnosis and pathology results. We queried the provincial cancer registry to ensure no cases of CRC were missed.Results: A total of 293 patients had acute diverticulitis diagnosed on CT scan, but 8 were nonresidents and were excluded. Of the 285 included in the analysis, the mean age was 59.4 ± 15.1 years, and 167 (58.6%) were men. Among the 114 patients who underwent follow-up evaluation, malignancy was diagnosed in 4 (3.5%). The overall prevalence of malignancy among patients with CT-diagnosed diverticulitis was 1.4%. Conclusion:Routine endoscopic evaluation after an episode of diverticulitis diagnosed with high-resolution CT scan does not appear to be necessary. Selective approach in patients with protracted clinical course or those with mass lesion/ obstruction on CT scan may be of benefit.Contexte : La tomodensitométrie (TDM) est couramment utilisée pour le diagnostic de la diverticulite aiguë, mais des caractéristiques sont communes à la diverticulite et au cancer colorectal (CCR) aux épreuves d'imagerie. On recommande donc en général la coloscopie après un épisode de diverticulite aiguë pour écarter un diagnostic de cancer sous-jacent. À l'heure actuelle, les appareils de TDM multidétecteurs à 64 barrettes peuvent fournir des images de haute résolution et permettent même de distinguer le cancer d'une inflammation diverticulaire. Nous avons voulu déterminer la prévalence du CCR chez les patients ayant présenté une diverticulite aiguë diagnostiquée par TDM. Résultats : En tout, 293 patients ont reçu un diagnostic de diverticulite à l'aide de la TDM; 8 étaient des non-résidents et ont été exclus. Parmi les 285 patients inclus dans l'analyse, l'âge moyen était de 59,4 ± 15,1 ans et 167 (58,6 %) étaient des hommes. Parmi les 114 patients qui ont subi un examen de suivi, le cancer a été diagnostiqué chez 4 (3,5 %). La prévalence globale du cancer chez les patients porteurs d'un diagnostic de diverticulite posé par TDM était de 1,4 %. Conclusion :L'évaluation endoscopique de routine après un épisode de diverticulite diagnostiquée à l'aide d'une TDM de haute résolution ne semble pas nécessaire. Une approc...

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Section: Discussionmentioning

confidence: 99%

Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary?

Rosenfeld

Brown

et al. 2015

cjs

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“…The risk of colorectal cancer in patients with acute diverticulitis is low, and there is good evidence in support of there being no need for routine colonoscopy following an episode of verified diverticulitis [15]. The assumptions that underlie these studies don't apply if symptoms consistent with diverticular disease have been managed in primary care without 9 radiographic imaging or endoscopy.…”

Section: Follow-up In Primary Carementioning

confidence: 99%

Diverticular Disease in the Primary Care Setting

Wensaas

Hungin

2016

Journal of Clinical Gastroenterology

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Diverticular disease is a chronic and common condition, and yet the impact of diverticular disease in primary care is largely unknown.The diagnosis of diverticular disease relies on the demonstration of diverticula in the colon, and the necessary investigations are often not available in primary care. The specificity and sensitivity of symptoms, clinical signs and laboratory tests alone are generally low and consequently the diagnostic process will be characterized by uncertainty. Also, the criteria for symptomatic uncomplicated diverticular disease in the absence of macroscopic inflammation are not clearly defined. Therefore both the prevalence of diverticular disease and the incidence of diverticulitis in primary care are unknown.Current recommendations for treatment and follow-up of patients with acute diverticulitis are based on studies where the diagnosis has been verified by computerized tomography. The results cannot be directly transferred to primary care where the diagnosis has to rely on the interpretation of symptoms and signs. Therefore, one must allow for greater diagnostic uncertainty, and safety netting in the event of unexpected development of the condition is an important aspect of the management of diverticulitis in primary care.The highest prevalence of diverticular disease is found among older patients, where multimorbidity and polypharmacy is common. The challenge is to remember the possible contribution of diverticular disease to the patient's overall condition and to foresee its implications in terms of advice and treatment in relation to other diseases.

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“…Colonoscopy verification should be warranted in patients with diverticulitis detected on CT, especially in those aged 50 years or older [62]. Sharma et al found that the pooled proportional estimate of malignancy was 1.6% (95% CI, 0.9%-2.8%) after an attack of acute diverticulitis, with a proportional estimate of risk 0.7% (CI, 0.3%-1.4%) in AUD and 10.8% (CI, 5.2%-21.0%) in complicated diverticulitis [61]. Finally, two recent systematic reviews [63,64] conclude (not surprisingly, because both include roughly the same papers) that broadly speaking, colonoscopy is not necessary to rule out CRC after an episode of AUD.…”

Section: Colonoscopy Following Acute Diverticulitismentioning

confidence: 99%

“…The vast majority of the studies draw the conclusion that colonoscopy after radiologically-confirmed uncomplicated diverticulitis is unnecessary to exclude malignancy [55][56][57][58][59][60], while it seems to be necessary after radiologically-confirmed complicated diverticulitis because the risk of malignancy in those patients is higher [61].…”

Section: Colonoscopy Following Acute Diverticulitismentioning

confidence: 99%

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

Tursi

2015

JGLD

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Diverticulosis of the colon is frequently found on routine colonoscopy, and the incidence of diverticular disease and its complications appears to be increasing. The role of colonoscopy in managing this disease is still controversial.Colonoscopy plays a key role in managing diverticular bleeding. Several techniques have been effectively used in this field, but band ligation seems to be the best in preventing rebleeding. Colonoscopy is also effective in posing a correct differential diagnosis with other forms of chronic colitis involving colon harbouring diverticula (in particular with Crohn's disease or Segmental Colitis Associated with Diverticulosis). The role of colonoscopy to confirm diagnosis of uncomplicated diverticulitis is still under debate, since the risk of advanced colonic neoplasia in patients admitted for acute uncomplicated diverticulitis is not increased as compared to the average-risk population. On the contrary, colonoscopy is mandatory if patients complain of persistent symptoms or after resolution of an episode of complicated diverticulitis. Finally, a recent endoscopic classification, called Diverticular Inflammation and Complications Assessment (DICA), has been developed and validated. This classification seems to be a promising tool for predicting the outcome of the colon harboring diverticula, but further, prospective studies have to confirm its predictive role on the outcome of the disease.

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Systematic Review and Meta-analysis of the Role of Routine Colonic Evaluation After Radiologically Confirmed Acute Diverticulitis

Cited by 150 publications

References 28 publications

Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary?

Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary?

Diverticular Disease in the Primary Care Setting

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

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