Efficacy of colonoscopy after an episode of acute diverticulitis and risk of colorectal cancer

Jeancarlos Jhosmer Trujillo Díaz; Beatriz De Andrés Asenjo; María Ruiz Soriano; Carlos Jezieniecki Fernández; Javier Ortiz de Solórzano Aurusa; Juan Beltrán de Heredia y Rentería

Authors Jeancarlos Jhosmer Trujillo Díaz, Beatriz De Andrés Asenjo, María Ruiz Soriano, Carlos Jezieniecki Fernández, Javier Ortiz de Solórzano Aurusa, Juan Beltrán de Heredia y Rentería.

Abstract

Background Diverticular disease of the colon has a high global prevalence. The guidelines suggest performing a colonoscopy 4-6 weeks after the acute episode to exclude colorectal cancer (CRC). However, these recommendations are based on old studies, when computed tomography was not used to diagnose acute diverticulitis (AD). There are currently some studies showing that CRC incidence is low in uncomplicated AD (UAD). Therefore, we decided to perform this study to determine the CRC incidence after an AD episode and the diagnostic efficacy of colonoscopy in these patients.

Method This was a retrospective cohort study that included patients with AD between July 2016 and December 2017.

Results One hundred seventy-four patients had AD. Of these, 46 patients were excluded and we analyzed 128 patients, 72 (56.3%) women and 56 (43.7%) men. Ninety (70.3%) had UAD and 38 (29.7%) complicated AD (CAD). The colonoscopy showed lesions in 18 (14.06%), 5 (3.9%) being CRC. The patients with CRC had shown CAD and were >70 years old (P=0.0001 and P=0.002 respectively).

Conclusions Routine colonoscopy in patients with UAD appears not have many benefits as a diagnostic tool. However, it has a higher efficacy if the patients have CAD and are >70 years old.

Keywords Colonic diverticular disease, acute diverticulitis, colorectal cancer, colonic neoplasm, colonoscopy

Ann Gastroenterol 2020; 33 (1): 68-72