What is the Risk of Colorectal Cancer After an Episode of Acute Diverticulitis in Conservatively Treated Patients?

Abstract

This study confirms that routine colonoscopy is not indicated after acute diverticulitis which has been treated conservatively in a large series. Only in case of alarm symptoms a colonoscopy is mandatory, but even then the actual finding of a colorectal cancer is rare.

Tumour Characteristics of Patients with Colorectal Cancer after Acute Uncomplicated Diverticulitis

“…Information on overall-and disease-free survival is presented in months. As subsequent follow-up on our earlier study regarding the risk of CRC after acute uncomplicated diverticulitis, part of these research methods match those from our earlier study [8].…”

“…According to Dutch guidelines, antibiotics are only administered in cases where the patient has a fever and is suspected of having bacteraemia or (severe) sepsis, if the patient is immunocompromised, or in cases of chronic non-steroidal antiinflammatory drug use. Alarm symptoms for CRC were defined as unintentional weight loss, a change in bowel habits, bloody stool and/or persistent abdominal pain [8]. These symptoms had to be present within 3 months after first presentation until the time at which colonoscopy was performed.…”

“…Burkitt was the first to formulate this hypothesis; however, this association is not entirely proven [3]. Some studies have found an increased risk for CRC after diverticulitis [4][5][6][7], while others did not [8][9][10][11][12][13]. In 1993, Stefánsson et al [14] suggested that positive associations could be explained by high concentrations of bacteria in the colon, some of which produce carcinogens.…”

“…The risk for CRC in patients after acute uncomplicated diverticulitis with alarm symptoms is 4.4 vs. 0.2% without alarm symptoms. Colonoscopy appears to be indicated in patients only with alarm symptoms for CRC such as rectal blood loss, unintentional weight loss and/ or persistent abdominal pain [8]. If CRC is diagnosed in such cases, it is unclear what the (tumour) characteristics are of those patients after an episode of uncomplicated acute diverticulitis.…”

“…In 2009, 18,355 patients were admitted compared to only 13,655 patients in 2006 [1]. In contrast, Dig Dis 2018;36:362-368 DOI: 10.1159/000489926 11,541 patients were diagnosed with CRC in 2015 (8,301 colon and 3,240 rectal) [2]. In the Western world, the localization of both diverticular disease and CRC occurs most commonly on the left side of the colon.…”