When to Perform a Colonoscopy in Diverticular Disease and Why: A Personalized Approach

Abstract

Colonoscopy is a crucial diagnostic tool in managing diverticular disease (DD). Diverticulosis can often be an unexpected diagnosis when colonoscopy is performed in asymptomatic subjects, generally for colorectal cancer screening, or it could reveal an endoscopic picture compatible with DD, including acute diverticulitis, in patients suffering from abdominal pain or rectal bleeding. However, alongside its role in the differential diagnosis of colonic diseases, particularly with colon cancer after an episode of acute diverticulitis or segmental colitis associated with diverticulosis, the most promising use of colonoscopy in patients with DD is represented by its prognostic role when the DICA (Diverticular Inflammation and Complication Assessment) classification is applied. Finally, colonoscopy plays a crucial role in managing diverticular bleeding, and it could sometimes be used to resolve other complications, particularly as a bridge to surgery. This article aims to summarize “when” to safely perform a colonoscopy in the different DD settings and “why”.

Endoscopic appearance is not sufficient for a diagnosis of segmental colitis associated with diverticulosis

“…In consequence, we may run the risk of over-diagnosing SCAD, and consequently its prevalence and treatment. This risk may also arise when endoscopic findings are adopted as single criteria, or when histology of the rectum is not performed, even in the absence of endoscopic signs of inflammation [ 10 ]. In fact, several other causes may mimic SCAD, ranging from inflammatory bowel diseases to infectious colitis, or to eosinophilic colitis.…”