Skip to main content

Advertisement

Log in

Do We Need Colonoscopy Following Acute Diverticulitis Detected on Computed Tomography to Exclude Colorectal Malignancy?

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Although colonoscopy verification is warranted after an acute event of diverticulitis to exclude underlying malignancy, little evidence is available to support the recommendations.

Aim

The aim of this study was to examine whether subsequent colonoscopy is warranted in patients with diverticulitis on computed tomography (CT).

Methods

The study was composed of patients diagnosed with acute diverticulitis on CT scan from January 2001 to March 2013. Patients who had subsequent colonoscopy within a year from the date of CT were included. For each diverticulitis case, two age- (±5 years) and sex-matched controls were identified from healthy individuals who had received screening colonoscopy. We evaluated the diagnostic yield of advanced colonic neoplasia in colonoscopy.

Results

One hundred and forty-nine patients underwent subsequent colonoscopy within a year from the date of CT. Among the patients, 11 (7.4 %) had colon cancer and 5 (3.4 %) had advanced adenoma. A case–control study revealed that the odds of detecting an advanced neoplasia among patients with diverticulitis on CT were approximately 8.8 times greater than in the age- and sex-matched controls [OR 8.84; 95 % CI 2.90–26.96; p < 0.001]. On analysis of the diverticulitis group, age (≥50 years) is an independent risk factor for detecting advanced colonic neoplasia.

Conclusions

The yield of advanced colonic neoplasia was substantially higher in patients with acute diverticulitis than in asymptomatic, average-risk individuals. Colonoscopy verification is warranted in patients with diverticulitis detected on CT, especially in those aged 50 years or older.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stollman N, Raskin JB. Diverticular disease of the colon. Lancet. 2004;363:631–639.

    Article  PubMed  Google Scholar 

  2. Loffeld RJ, Van Der Putten AB. Diverticular disease of the colon and concomitant abnormalities in patients undergoing endoscopic evaluation of the large bowel. Colorectal Dis. 2002;4:189–192.

    Article  PubMed  Google Scholar 

  3. Painter NS, Burkitt DP. Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol. 1975;4:3–21.

    CAS  PubMed  Google Scholar 

  4. Morini S, Zullo A, Hassan C, Tomao S, Campo SM. Diverticulosis and colorectal cancer: between lights and shadows. J Clin Gastroenterol. 2008;42:763–770.

    Article  PubMed  Google Scholar 

  5. Stefansson T, Ekbom A, Sparen P, Påhlman L. Association between sigmoid diverticulitis and left-sided colon cancer: a nested, population-based, case control study. Scand J Gastroenterol. 2004;39:743–747.

    Article  CAS  PubMed  Google Scholar 

  6. Lam T, Meurs-Szojda M, Gundlach L, et al. There is no increased risk for colorectal cancer and adenomas in patients with diverticulitis: a retrospective longitudinal study. Colorectal Dis. 2010;12:1122–1126.

    Article  CAS  PubMed  Google Scholar 

  7. Lawrimore T, Rhea JT. Computed tomography evaluation of diverticulitis. J Intensive Care Med. 2004;19:194–204.

    Article  PubMed  Google Scholar 

  8. Ambrosetti P, Jenny A, Becker C, Terrier F, Morel P. Acute left colonic diverticulitis—compared performance of computed tomography and water-soluble contrast enema. Dis Colon Rectum. 2000;43:1363–1367.

    Article  CAS  PubMed  Google Scholar 

  9. Bahadursingh AM, Virgo KS, Kaminski DL, Longo WE. Spectrum of disease and outcome of complicated diverticular disease. Am J Surg. 2003;186:696–701.

    Article  PubMed  Google Scholar 

  10. Rafferty J, Shellito P, Hyman NH, Buie WD. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006;49:939–944.

    Article  PubMed  Google Scholar 

  11. Jacobs DO. Diverticulitis. N Engl J Med. 2007;357:2057–2066.

    Article  CAS  PubMed  Google Scholar 

  12. Stollman NH, Raskin JB. Diagnosis and management of diverticular disease of the colon in adults. Am J Gastroenterol. 1999;94:3110–3121.

    Article  CAS  PubMed  Google Scholar 

  13. Westwood D, Eglinton T, Frizelle F. Routine colonoscopy following acute uncomplicated diverticulitis. Br J Surg. 2011;98:1630–1634.

    Article  CAS  PubMed  Google Scholar 

  14. Gatto NM, Frucht H, Sundararajan V, Jacobson JS, Grann VR, Neugut AI. Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study. J Natl Cancer Inst. 2003;95:230–236.

    Article  PubMed  Google Scholar 

  15. Lahat A, Yanai H, Menachem Y, Avidan B, Bar-Meir S. The feasibility and risk of early colonoscopy in acute diverticulitis: a prospective controlled study. Endoscopy. 2007;39:521–524.

    Article  CAS  PubMed  Google Scholar 

  16. Anderson JC, Messina CR, Cohn W, et al. Factors predictive of difficult colonoscopy. Gastrointest Endosc. 2001;54:558–562.

    Article  CAS  PubMed  Google Scholar 

  17. Hur S, Kim HC, Chung JW, et al. Hepatocellular carcinomas smaller than 4 cm supplied by the intercostal artery: can we predict which intercostal artery supplies the tumor? Korean J Radiol. 2011;12:693–699.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Chintapalli KN, Chopra S, Ghiatas AA, Esola CC, Fields SF, Dodd GD 3rd. Diverticulitis versus colon cancer: differentiation with helical CT findings. Radiology. 1999;210:429–435.

    Article  CAS  PubMed  Google Scholar 

  19. Meurs-Szojda M, sive Droste JT, Kuik D, Mulder C, Felt-Bersma R. Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4, 241 colonoscopies. Int J Colorectal Dis. 2008;23:979–984.

    Article  CAS  PubMed  Google Scholar 

  20. Krones C, Klinge U, Butz N, et al. The rare epidemiologic coincidence of diverticular disease and advanced colonic neoplasia. Int J Colorectal Dis. 2006;21:18–24.

    Article  CAS  PubMed  Google Scholar 

  21. Schout PJ, Spillenaar Bilgen EJ, Groenen MJ. Routine screening for colon cancer after conservative treatment of diverticulitis. Dig Surg. 2012;29:408–411.

    Article  PubMed  Google Scholar 

  22. Lau K, Spilsbury K, Farooque Y, et al. Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded? Dis Colon Rectum. 2011;54:1265–1270.

    Article  CAS  PubMed  Google Scholar 

  23. Elmi A, Hedgire SS, Pargaonkar V, Cao K, McDermott S, Harisinghani M. Is early colonoscopy beneficial in patients with CT-diagnosed diverticulitis? AJR Am J Roentgenol. 2013;200:1269–1274.

    Article  PubMed  Google Scholar 

  24. Brar MS, Roxin G, Yaffe PB, Stanger J, Maclean AR, Buie WD. Colonoscopy following nonoperative management of uncomplicated diverticulitis may not be warranted. Dis Colon Rectum. 2013;56:1259–1264.

    Article  PubMed  Google Scholar 

  25. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130–160.

    Article  PubMed  Google Scholar 

  26. Lansdorp-Vogelaar I, von Karsa L. European guidelines for quality assurance in colorectal cancer screening and disgnosis. First Edition—Introduction. Endoscopy. 2012;44(S03):SE15–SE30.

    Google Scholar 

  27. Lee BI, Hong SP, Kim SE, et al. Korean guidelines for colorectal cancer screening and polyp detection. Clin Endosc. 2012;45:25–43.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Byeong Gwan Kim.

Additional information

Young Hoon Choi and Seong-Joon Koh have contributed equally to this article.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Choi, Y.H., Koh, SJ., Kim, J.W. et al. Do We Need Colonoscopy Following Acute Diverticulitis Detected on Computed Tomography to Exclude Colorectal Malignancy?. Dig Dis Sci 59, 2236–2242 (2014). https://doi.org/10.1007/s10620-014-3151-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-014-3151-1

Keywords

Navigation