There Is No Role for Colonoscopy after Diverticulitis among Asian Patients Less than 50 Years of Age

Abstract

Background: Colonoscopy is advocated following acute diverticulitis to ensure that malignancy is not missed. In an Asian population, diverticulitis is more common in the right colon and in younger patients. The purpose of this study is to examine the utility of colonoscopy amongst Asian patients <50 years of age who have had colonic diverticulitis. Methods: A retrospective review of all patients aged 50 years and under who were treated for colonic diverticulitis between 2012 and 2014 was performed. All patients were advised to undergo a colonoscopy when the diverticulitis had settled, and findings at colonoscopy were recorded. Results: Fifty-five patients aged <50 years had acute diverticulitis. Forty-eight (87.3%) had right-sided diverticulitis. Amongst them, 45 (93.8%) had Hinchey 1a, 1b or 2 diverticulitis, while none had Hinchey 4 diverticulitis. Excluding the only patient that underwent a colonic resection, 27 (50.0%) patients returned for a colonoscopy. None of these patients were found to have colorectal cancer or an advanced adenoma. Six (11.1%) of them had adenomas with low-grade dysplasia. Conclusion: Right-sided diverticulitis is more common in the young Asian population. Most patients can be conservatively treated. Follow-up colonoscopy may not be required in these patients.

Risk of Colorectal Cancer in Patients With Acute Diverticulitis: A Systematic Review and Meta-analysis of Observational Studies

“…8, These articles were recent; 23 were published in the last 5 years. 8,[19][20][21][22][23][24][25][26][27][28][29][30][33][34][35][36][37][38]41,42,45 Nineteen studies were monocentric, 8,[16][17][18]20,22,25,26,28,30,31,34,[37][38][39][41][42][43][44] eight were multicentric, 21,23,24,29,32,33,35,45 and four were population-based. 19,27...…”

“…19,27,36,40 Data of 6 studies were prospectively collected, [16][17][18]21,24,29 24 were retrospectively collected, 8,19,20,22,23,25,27,28,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] and one study did not specify the nature of data collection. 26 Two studies included only young patients (<50 years 22 and <40 years 42 ). Six publications excluded patients with complicated diverticulitis, 16,17,19,29,38,44 twelve studies excluded patients without direct colonic evaluation, [16][17][18]20,21,[23]…”

“…Thirty-one studies totalling 50,445 patients reported the prevalence of colorectal cancer in diverticulitis patients 8, (Supplementary Table 4). The presence of colorectal cancer was determined by direct colonic evaluation in 20 studies (5273 patients) [16][17][18][20][21][22][23][24][25][26]28,29,33,34,[38][39][40][41][42][43] and by consultation of cancer registries in 11 studies (45,172 patients). 8,19,27,[30][31][32][35][36][37]44,45 For the latter studies, the follow-up period in cancer registries was 1 year for 4 studies, 19,27,32,35 two years for 1 study, 8 and variable for 5 studies.…”

“…The proportion of patients with colorectal cancer ranged between 0% 16,18,21,22,30,39,42 and 7.4% 23 (Supplementary Table 4). The pooled prevalence of colorectal cancer was 1.9% (95% confidence interval [CI], 1.5%-2.3%; I 2 , 57%) ( Figure 2).…”

“…The prevalence was 1.1% (95% CI, 0.6%-2.1%; I 2 , 63.9%) by pooling only studies including >200 patients. Then, we performed sensitivity analyses according to the methodological quality of the included studies based on the Newcastle-Ottawa scale by separately pooling studies reporting the proportion of colorectal cancer in patients with uncomplicated diverticulitis (15 studies, 8,16,17,19,20,22,23,29,30,34,35,38,39,41,44 3834 patients) and complicated diverticulitis (9 studies, 8,20,22,23,30,34,35,39,41 641 patients) ( Table 3). Nine studies 8,20,23,30,34,35,39,41,44 reported the numbers of colorectal cancer in both patients with complicated and uncomplicated diverticulitis.…”