Colonoscopy is recommended following the diagnosis of diverticulitis to identify potential colorectal cancer (CRC), given the high prevalence of CRC following the diagnosis of diverticulitis, according to study results published in Gastrointestinal Endoscopy.
Diverticulitis is a common adverse event, occurring in anywhere between 5% and 25% of patients with diverticula. Clinical guidelines suggest that colonoscopy be performed in patients with first-episode acute diverticulitis or with no history of colonoscopy; however, the efficacy of this testing has remained uncertain. Most patients with diverticulitis have uncomplicated disease, with complicated cases at higher risk for neoplasia. The objective of this study was to examine the incidence of advanced adenoma (AA) and CRC in patients with a diagnosis of diverticulitis compared with patients undergoing a screening colonoscopy.
In this study, researchers performed a retrospective analysis of 978 patients at 2 University of Pittsburgh Medical Center (UPMC) hospitals with confirmed acute diverticulitis. Gastrointestinal surgery, colonoscopy, and pathology reports for AA and CRC diagnoses were reviewed and evaluated, and all patients were followed for at least 2 years. Researchers compared the incidence of AA and CRC in this cohort with that observed in historical controls using data from meta-analysis of 68,324 patients who received screening colonoscopy and 28,573 patients who received colonoscopy exams at UPMC between 2013 and 2015.
Results revealed that among the 978 patients with diverticulitis, 474 (48.5%) had at least 1 colonoscopy or gastrointestinal surgery through follow-up to April 2015. There were 19 patients diagnosed with AA (4%) and 13 patients diagnosed with CRC (2.7%). The AA rate in this cohort was similar to the AA rate in the meta-analysis (5%, P =.39) but lower than the AA rate at UPMC (7.7%, P =.003). The CRC rate was significantly higher in this cohort (P <.0001) compared with the CRC rates in the meta-analysis and at UPMC (0.8% and 0.3%, respectively). The incidence of AA or CRC in patients with complicated diverticulitis (10/141, 7.1%) did not differ significantly (P = 0.85) from the incidence of AA or CRC in patients with uncomplicated diverticulitis (22/332, 6.6%).
This study had several limitations. First, this was a retrospective study of medical records at a single institution and the institution is a quaternary care center, meaning its patient population may represent a higher number of complicated cases. This may have inflated the findings of CRC compared with that of the general population; also, a large portion of the cohort did not receive a follow-up procedure to detect for neoplasia. Additionally, researchers did not consider other factors that may have affected the incidence of CRC in the cohort, such as family history of CRC and comorbidities.
The study researchers concluded that the rate of CRC after diverticulitis is significantly higher than the rate observed at screening colonoscopy, regardless of whether the disease is complicated, and that colonoscopy should be performed following diverticulitis diagnosis.
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 [published online September 12, 2019]. Gastrointest Endosc. doi: 10.1016/j.gie.2019.08.044