Acute Diverticulitis Still an Indication for Colonoscopy
Acute diverticulitis is generally considered an indication for colonoscopy, but the results of studies have been mixed with regard to the risk of colorectal cancer (CRC) after acute diverticulitis.
In a new study, 5167 abdominal/pelvic CT scans, reviewed at a single U.S. medical center, identified 978 patients with acute diverticulitis, of whom 48.5% had at least one colonoscopy or gastrointestinal surgery during 2 years of follow-up. There was no increase in the incidence of advanced adenoma after diverticulitis, but the risk of CRC (2.7%, or 13 out of 474 cases) was substantially higher than that identified in a meta-analysis of screening colonoscopy or from screening colonoscopy at the study center (0.8% and 0.3%, respectively). There was no difference in the risk after complicated versus uncomplicated diverticulitis. Nine of 13 incident cancers were in the sigmoid, 2 in the ascending, and 2 in the rectum, although all the diverticulitis was on the left side in the cancer patients.
Comment:
These data favor the traditional recommendation to perform colonoscopy a few weeks after a diagnosis of acute diverticulitis. The real challenge is how often colonoscopy needs to be repeated in patients with recurrent attacks of acute diverticulitis who have already had colonoscopy. The study did not address that clinically important issue.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Douglas K. Rex, MD, FASGE
Citation(s):
Tehranian S, Klinge M, Saul M, Morris M, Diergaarde B, Schoen RE. Prevalence of colorectal cancer and advanced adenoma in patients with acute diverticulitis: implications for follow-up colonoscopy. Gastrointest Endosc 2019 Sep 12. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2019.08.044)
