The connection between diverticulosis and colonic superficial neoplastic lesions in patients who underwent screening colonoscopy

Abstract

Purpose If could be a potential pathophysiological connection between colonic diverticula and colonic superficial neoplastic lesions, beyond the shared risk factors, has been a subject of debate in the last years. This study tries to evaluate the association between diverticulosis and colonic neoplastic lesions. Methods This is a cross-sectional study including asymptomatic patients who underwent a screening colonoscopy (patients with a positive fecal occult blood test under the regional program of colorectal cancer (CRC) screening), surveillance after polypectomy resection, or familiarity (first-degree relatives) between 2020 and 2021 to evaluate the association between diverticula and colonic polyps. A multivariate analysis with multiple logistic regression and odds ratio (OR) to study the independent association between adenomas and adenocarcinomas was performed. Results One thousand five hundred one patients were included. A statistically significant association between adenomas or CRC alone and colonic diverticula was found (p = 0.045). On a multivariate analysis of demographic (age, gender) and clinical parameters (familiarity for diverticula and adenoma/CRC), only age was significantly associated with the development of colorectal adenomas or cancer (OR 1.05, 95% CI 1.03–1.07, p < 0.0001). Conclusions This study showed a statistically significant association between diverticula and colonic adenomas. However, it is impossible to establish a cause-effect relationship due to the intrinsic characteristics of this study design. A study with a prospective design including both patients with diverticulosis and without colonic diverticula aimed at establishing the incidence of adenoma and CRC could help to answer this relevant clinical question, since a potential association could indicate the need for closer endoscopic surveillance.

Brief Explanation About Diverticular Disease

“…Epidemiological studies have attempted to characterize the association between diverticular disease and colorectal cancer, yielding inconsistent results [13]. Additionally, the presence of associated symptoms such as abdominal pain, bloating, diarrhea, and constipation in the absence of inflammation of peri-diverticular mucosa identifies symptomatic uncomplicated diverticular disease (SUDD) [14]. Furthermore, the characteristic pathologic features of Crohn's disease, such as transmural inflammation, epithelioid cell granuloma, fissuring, or fistula formation, may be seen in complicated diverticular disease or diverticulitis [15].…”