Skip to main content
SpringerLink
Log in

Endoscopic evaluation of the colon after an episode of diverticulitis: a call for a more selective approach

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Routine colonic evaluation is advised after an episode of diverticulitis to exclude colorectal cancer. In the recent years, the possible relation between diverticulitis and colorectal cancer has been subject of debate. The aim of this study is to evaluate the benefit of routine colonic endoscopy after an episode of diverticulitis.

Methods

Records of all consecutive patients presenting with a radiologically confirmed episode of diverticulitis between 2007 and 2010 were retrieved from an in-hospital database. Patients who subsequently underwent colonic evaluation were included. The endoscopic detection rate of hyperplastic polyps, adenomas and advanced colonic neoplasia was assessed. Findings were categorized on the basis of the most advanced lesion identified.

Results

Three hundred and seven patients presented with a radiologically confirmed primary episode of diverticulitis. Two hundred and five patients underwent colonic evaluation. Hyperplastic polyps were found in15 (6.8 %), adenomas in 18 (8.8 %) and advanced neoplastic lesions in 7 (3.4 %) patients. Only two patients had a colorectal malignancy.

Conclusion

There appears to be no benefit in performing routine colonic evaluation after an episode of diverticulitis as the incidence of colorectal cancer is almost equal to that of the general population. A more selective approach might therefore be justified. Potentially, only patients with persisting abdominal complaints after an episode of diverticulitis should be offered colonic evaluation to definitively exclude causal pathology.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Etzioni DA, Mack TM, Beart RW Jr et al (2009) Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 249(2):210–7

    Article  PubMed  Google Scholar 

  2. Munson KD, Hensien MA, Jacob LN et al (1996) Diverticulitis. A comprehensive follow-up. Dis Colon Rectum 39(3):318–22

    Article  PubMed  CAS  Google Scholar 

  3. Delvaux M (2003) Diverticular disease of the colon in Europe: epidemiology, impact on citizen health and prevention. Aliment Pharmacol Ther 18(Suppl 3):71–4

    Article  PubMed  Google Scholar 

  4. Sandler RS, Everhart JE, Donowitz M et al (2002) The burden of selected digestive diseases in the United States. Gastroenterology 122(5):1500–11

    Article  PubMed  Google Scholar 

  5. Mimura T, Emanuel A, Kamm MA (2002) Pathophysiology of diverticular disease. Best Pract Res Clin Gastroenterol 16(4):563–76

    Article  PubMed  Google Scholar 

  6. Morini S, Hassan C, Zullo A et al (2005) Epithelial cell proliferation of the colonic mucosa in diverticular disease: a case–control study. Aliment Pharmacol Ther 21(11):1385–90

    Article  PubMed  CAS  Google Scholar 

  7. Jacobs DO (2007) Diverticulitis. N Engl J Med 357:2057–66

    Article  PubMed  CAS  Google Scholar 

  8. Rafferty J, Shellito P, Hyman NH et al (2006) Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 49(7):939–44

    Article  PubMed  Google Scholar 

  9. Westwood DA, Eglinton TW, Frizelle FA (2011) Routine colonoscopy following acute uncomplicated diverticulitis. Br J Surg 98(11):1630–4

    Article  PubMed  CAS  Google Scholar 

  10. Lau KC, Spilsbury K, Farooque Y, Kariyawasam SB, Owen RG, Wallace MH, Makin GB (2011) Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded? Dis Colon Rectum 54(10):1265–70

    Article  PubMed  CAS  Google Scholar 

  11. Kaiser AM, Jiang JK, Lake JP et al (2005) The management of complicated diverticulitis and the role of computed tomography. Am J Gastronenterol 100:910–917

    Article  Google Scholar 

  12. Lam TJ, Meurs-Szojda MM, Gundlach L, Belien JA, Meijer GA, Mulder CJ, Felt-Bersma RJ (2010) There is no increased risk for colorectal cancer and adenomas in patients with diverticulitis: a retrospective longitudinal study. Colorectal Dis 12(11):1122–6

    Article  PubMed  CAS  Google Scholar 

  13. Niv Y, Hazazi R, Levi Z, Fraser G (2008) Screening colonoscopy for colorectal cancer in asymptomatic people: a meta-analysis. Dig Dis Sci 53(12):3049–54

    Article  PubMed  Google Scholar 

  14. Bokemeyer B, Bock H, Hüppe D, Düffelmeyer M, Rambow A, Tacke W, Koop H (2009) Screening colonoscopy for colorectal cancer prevention: results from a German online registry on 269000 cases. Eur J Gastroenterol Hepatol 21(6):650–5

    Article  PubMed  Google Scholar 

  15. Peppas G, Bliziotis IA, Oikonomaki D, Falagas ME (2007) Outcomes after medical and surgical treatment of diverticulitis: a systematic review of the available evidence. J Gastroenterol Hepatol 22(9):1360–8

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Meander Medical Center, P.O. Box 1502, 3800 BM, Amersfoort, the Netherlands

    Bryan J. M. van de Wall, Ellen M. B. P. Reuling, Esther C. J. Consten, Janneke H. J. van Grinsven, Ivo A. M. J. Broeders & Werner A. Draaisma

  2. Department of Gastroenterology, Meander Medical Center, P.O. Box 1502, 3800 BM, Amersfoort, the Netherlands

    Matthijs P. Schwartz

Authors
  1. Bryan J. M. van de Wall
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ellen M. B. P. Reuling
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Esther C. J. Consten
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Janneke H. J. van Grinsven
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthijs P. Schwartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ivo A. M. J. Broeders
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Werner A. Draaisma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Werner A. Draaisma.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van de Wall, B.J.M., Reuling, E.M.B.P., Consten, E.C.J. et al. Endoscopic evaluation of the colon after an episode of diverticulitis: a call for a more selective approach. Int J Colorectal Dis 27, 1145–1150 (2012). https://doi.org/10.1007/s00384-012-1448-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-012-1448-0

Keywords

Search

Navigation