Diverticulosis and neoplastic lesions in screening colonoscopy: a large, multicenter study

Paolo Fedeli; Monica Masotti; Chiara Marzano; Angelo Dezi; Giuseppe Scaccianoce; Elisabetta Martinelli; Lucia Montenegro; Maurizio Giovannone; Alessandra Zannella; Alessandro Gigliozzi; Roberto Bringiotti; Costantino Zampaletta; Maria Carlotta Sacchi; Lorenzo Ridola; Alessandra Spagnoli; Sabrina Berardi; Angelo Zullo

Authors Paolo Fedeli, Monica Masotti, Chiara Marzano, Angelo Dezi, Giuseppe Scaccianoce, Elisabetta Martinelli, Lucia Montenegro, Maurizio Giovannone, Alessandra Zannella, Alessandro Gigliozzi, Roberto Bringiotti, Costantino Zampaletta, Maria Carlotta Sacchi, Lorenzo Ridola, Alessandra Spagnoli, Sabrina Berardi, Angelo Zullo.

Abstract

Background Data on the potential association between diverticulosis and colonic neoplastic lesions are still controversial. We investigated this issue in subjects who underwent screening colonoscopy.

Methods We reviewed the data of subjects with a positive fecal immunological test who underwent a first colonoscopy in the national colorectal screening program. Endoscopic and histological reports were evaluated, using both univariate and multivariate analyses to search for an association between diverticulosis and colonic neoplastic lesions.

Results Data from 5050 subjects (males: 52.2%; mean age: 61.7±6.5 years) observed in the 7 participating centers were considered. Diverticula were found in 2176 (43.1%) cases; at least 1 adenoma was detected in 2277 (45.1%) patients, at least 1 advanced adenoma in 842 (16.7%); and cancer was diagnosed in 159 (3.1%) cases. By univariate analysis, the prevalence of adenomas in patients with diverticula (46.7%, 95% confidence interval [CI] 44.6-48.8%) was significantly higher than in controls (43.8%, 95%CI 42.1-45.7%; P=0.041), while prevalences of both advanced adenomas (13.8%, 95%CI 16.3-19.5%) and cancers (2.4%, 95%CI 1.7-3.1% vs. 3.7%, 95%CI 3.1-4.4%) were lower. By multivariate analysis, only male sex (odds ratio [OR] range: 1.54-2.05) and age (OR range: 1.03-1.05) were found to
be independent variables associated with different neoplastic lesions in the colon, whilst diverticulosis was not.

Conclusion This large, multicenter study found no significant association between diverticulosis and neoplastic lesions in subjects who underwent screening colonoscopy.

Keywords Diverticulosis, adenoma, cancer, screening, colonoscopy

Ann Gastroenterol 2025; 38 (1): 68-71