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Yield of colonoscopy after recent CT-proven uncomplicated acute diverticulitis: a comparative cohort study

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Abstract

Background

Current guidelines recommend routine follow-up colonoscopy after acute diverticulitis to confirm the diagnosis and exclude malignancy. Its value, however, has recently been questioned because of contradictory study results. Our objective was to compare the colonoscopic detection rate of advanced colonic neoplasia (ACN), comprising colorectal cancer (CRC) and advanced adenoma (AA), in patients after a CT-proven primary episode of uncomplicated acute diverticulitis with average risk participants in a primary colonoscopy CRC screening program.

Methods

A retrospective comparison was performed of prospectively collected data from cohorts derived from two multicenter randomized clinical trials executed in the Netherlands between 2009 and 2013. 401 uncomplicated diverticulitis patients and 1,426 CRC screening participants underwent colonic evaluation by colonoscopy. Main outcome was the diagnostic yield for ACN, calculated as number of diverticulitis patients and screening participants with ACN relative to their totals, with differences expressed as odds ratios (OR). The histopathology outcome of removed lesions during colonoscopy was used as definitive diagnosis.

Results

AA detection was similar [5.5 vs. 8.7 %; OR 0.62 (95 % CI 0.38–1.01); P = 0.053]. CRC was detected in 1.2 % (5/401) of diverticulitis patients versus 0.6 % (9/1,426) of screening participants [OR 1.30 (95 % CI 0.39–4.36); P = 0.673]. ACN was diagnosed in 6.7 % (27/401) of diverticulitis patients versus 9.1 % (130/1,426) of screening participants [OR 0.71 (95 % CI 0.45–1.11); P = 0.134]. ORs were adjusted for age, family history of CRC, smoking, BMI, and cecal intubation rate.

Conclusions

ACN detection does not differ significantly between patients with recent uncomplicated diverticulitis and average risk screening participants. Routine follow-up colonoscopy after primary CT-proven uncomplicated left-sided acute diverticulitis can be omitted; these patients can participate in CRC screening programs. Follow-up colonoscopy may be beneficial when targeted at high-risk patients, but such an approach first needs prospective evaluation.

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Acknowledgment

The COCOS trial, from which the screening cohort for this study was derived, was funded by the Netherlands Organisation for Health Research and Development of the Dutch Ministry of Health (ZonMw No. 120720012), Centre for Translational Molecular Medicine (CTMM DeCoDe-project), and the Nuts Ohra Foundation (Amsterdam, The Netherlands). The DIABOLO trial, from which the diverticulitis patient cohort was derived, was also funded by ZonMw (No. 171002303) and by the Dutch Maag Lever Darm Stichting (MLDS No. WO08-54). The funders had no role in study design, data collection and analysis, data interpretation, decision to publish, writing or preparation of the manuscript.

Disclosures

Prof. Boermeester has received grants from Baxter, GSK, LifeCell, Ipsen, and Abbott for work outside this specific paper. Prof. Dekker has received speaker fees from Norgine Spain and Takada and research support and equipment on loan from Olympus for work outside this specific paper. Drs. Daniels, Drs. Ünlü, Dr. de Wijkerslooth, Dr. Stockmann, and Prof. Kuipers have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery – G4, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Lidewine Daniels, Çağdaş Ünlü & Marja A. Boermeester

  2. Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands

    Thomas R. de Wijkerslooth & Evelien Dekker

  3. Department of Surgery, Kennemer Gasthuis Hospital, Haarlem, The Netherlands

    Hein B. Stockmann

  4. Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands

    Ernst J. Kuipers

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  1. Lidewine Daniels
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  2. Çağdaş Ünlü
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Correspondence to Lidewine Daniels.

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Daniels, L., Ünlü, Ç., de Wijkerslooth, T.R. et al. Yield of colonoscopy after recent CT-proven uncomplicated acute diverticulitis: a comparative cohort study. Surg Endosc 29, 2605–2613 (2015). https://doi.org/10.1007/s00464-014-3977-9

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