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Interval colonoscopy following acute diverticulitis should not be discouraged yet: results from a retrospective cohort

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Abstract

Background

Although included in some guidelines, the recommendation of interval colonoscopy after an acute diverticulitis (AD) episode has recently been questioned. In this study, we evaluated the incidence of colon cancer during the follow-up of an episode of AD.

Methods

A retrospective review was carried out of patients with conservatively treated AD at our Institution (January 2011 to December 2018) with or without endoscopic study. Patients who had no colonoscopy performed were followed for two years. The demographic, clinical, radiological, follow-up and anatomopathological records were analysed. We determined CT scan validity for the differential diagnosis of CC and AD; sensibility, specificity, predictive values and likelihood ratios were calculated. Patients lost to follow-up and patients who had had colonoscopy in the previous three years were excluded.

Results

This study included 285 patients with a mean age of 59 years. A total of 225 interval colonoscopies were performed and 60 patients without colonoscopy were followed up. There were 19 CC (6.7%) diagnosed, 14 with interval colonoscopy and 5 during follow-up; 8 (42.1%) happened in patients who had had an episode of uncomplicated AD. Although CT scan accuracy is high, 87.7%, positive and negative likelihood ratios were low, 4.67 and 0.64, respectively.

Conclusions

Interval colonoscopy should still be advisable after an episode of AD. The rationale for this statement is based on a non-negligible rate of hidden CC and an important uncertainty in the differential diagnosis.

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References

  1. Rottier SJ, vanDijk ST, van Geloven AAW, Schreurs WH, Draaisma WA, van Enst WA, Puylaert JBCM, de Boer MGJ, Klarenbeek BR, Otte JA, Felt RJF, Boermeester MA (2019) Meta-analysis of the role of colonoscopy after an episode of left-sided acute diverticulitis. BJS 106:988–997

    Article  CAS  Google Scholar 

  2. O’Donohoe N, Chandak P, Likos-Corbett M, Yee J, Hurndall K, Rao C, Engledow AH (2019) Follow up colonoscopy may be omissible in uncomplicated left-sided acute diverticulitis diagnosed with CT- a retrospective cohort study. Sci Rep. https://doi.org/10.1038/s41598-019-56641-2,December27

    Article  PubMed  PubMed Central  Google Scholar 

  3. Stollman N, Smalley W, Hirano I, AGA Institute Clinical Guidelines Committee (2015) American gastroenterological association institute guideline on the management of acute diverticulitis. Gastroenterology 149:1944–1949

    Article  Google Scholar 

  4. Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD, Rafferty JF (2014) Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 57:284–294

    Article  Google Scholar 

  5. Andeweg CS, Mulder IM, Felt-Bersma RJ, Verbon A, van der Wilt GJ, van Goor H, Lange JF, Stoker J, Boermeester MA, Bleichrodt RP, Netherlands Society of Surgery, Working group from Netherlands Societies of Internal Medicine, Gastroenterologists, Radiology, Health Technology Assessment and Dieticians (2013) Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg 30(278):292

    Google Scholar 

  6. Sartelli M, Catena F, Ansaloni L, Coccolini F, Griffiths EA, Abu-Zidan FM, Di Saverio S, Ulrych J, Kluger Y, Ben-Ishay O, Moore FA, Ivatury RR, Coimbra R, Peitzman AB, Leppaniemi A, Fraga GP, Maier RV, Chiara O, Kashuk J, Sakakushev B, Weber DG, Latifi R, Biffl W, Bala M, Karamarkovic A, Inaba K, Ordonez CA, Hecker A, Augustin G, Demetrashvili Z, Melo RB, Marwah S, Zachariah SK, Shelat VG, McFarlane M, Rems M, Gomes CA, Faro MP, Júnior GA, Negoi I, Cui Y, Sato N, Vereczkei A, Bellanova G, Birindelli A, Di Carlo I, Kok KY, Gachabayov M, Gkiokas G, Bouliaris K, Çolak E, Isik A, Rios-Cruz D, Soto R, Moore EE (2016) WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting. World J Emerg Surg 11:37

    Article  Google Scholar 

  7. Francis NK, Sylla P, Abou-Khalil M, Arolfo S, Berler D, Curtis NJ, Dolejs SC, Garfinkle R, Gorter-Stam M, Hashimoto DA, Hassinger TE, Molenaar CJL, Pucher PH, Schuermans V, Arezzo A, Agresta F, Antoniou SA, Arulampalam T, Boutros M, Bouvy N, Campbell K, Francone T, Haggerty SP, Hedrick TL, Stefanidis D, Truitt MS, Kelly J, Ket H, Dunkin BJ, Pietrabissa A (2019) EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice. Surg. Endosc 33:2726–2741

    Article  Google Scholar 

  8. Klarenbeek BR, de Korte N, van der Peet DL, Cuesta MA (2012) Review of current classifications for diverticular disease and a translation into clinical practice. Int J Colorectal Dis 27:207–214

    Article  Google Scholar 

  9. van Randen A, Laméris W, van Es HW, van Heesewijk HPM, van Ramshorst B, ten Hove W, Bouma WH, van Leeuwen MS, van Keulen EM, Bossuyt PM, Stoker J, Boermeester MA, on behalf of the OPTIMA study group (2011) A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol 21:1535–1545

    Article  Google Scholar 

  10. Laméris W, van Randen A, Bipat S, Bossuyt PMM, Boermeester MA, Stoker J (2008) Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: Meta-analysis of test accuracy. Eur Radiol 18:2498–2511

    Article  Google Scholar 

  11. Kaiser AM, Jiang JK, Lake JP, Ault G, Artinyan A, Gonzalez-Ruiz C, Essani R, Beart RW Jr (2005) The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 100:910–917

    Article  Google Scholar 

  12. Gupta S, Lieberman D, Anderson JC, Burke CA, Dominitz JA, Kaltenbach T, Robertson DJ, Shaukat A, Syngal S, Rex DK (2020) Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the us multi-society task force on colorectal cancer. Am J Gastroenterol 115:415–434

    Article  Google Scholar 

  13. Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, Dixon MF, Fenoglio-Preiser CM, Fléjou JF, Geboes K, Hattori T, Hirota T, Itabashi M, Iwafuchi M, Iwashita A, Kim YI, Kirchner T, Klimpfinger M, Koike M, Lauwers GY, Lewin KJ, Oberhuber G, Offner F, Price AB, Rubio CA, Shimizu M, Shimoda T, Sipponen P, Solcia E, Stolte M, Watanabe H, Yamabe H (2000) The Vienna classification of gastrointestinal epithelial neoplasia. Gut 47:251–255

    Article  CAS  Google Scholar 

  14. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457

    Article  Google Scholar 

  15. Grahnat CJ, Hérard S, Ackzell A, Andersson RE (2016) High Probability of an Underlying Colorectal Cancer Among Patients Treated for Acute Diverticulitis. A Population-Based Cohort Follow-Up Study. World J Surg 40:2283–2288

    Article  Google Scholar 

  16. Choi YH, Koh SJ, Kim JW, Kim BG, Lee KL, Im JP, Kim JS, Jung HC (2014) Do we need colonoscopy following acute diverticulitis detected on computed tomography to exclude colorectal malignancy? Dig Dis Sci 59:2236–42

    Article  Google Scholar 

  17. Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte SJ, Etzioni R, McKenna MT, Oeffinger KC, Shih YT, Walter LC, Andrews KS, Brawley OW, Brooks D, Fedewa SA, Manassaram-Baptiste D, Siegel RL, Wender RC, Smith RA (2018) Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin 68:250–281

    Article  Google Scholar 

  18. Andrade P, Ribeiro A, Ramalho R, Lopes S, Macedo G (2017) routine colonoscopy after acute uncomplicated diverticulitis - challenging a putative indication. Dig Surg 34:197–202

    Article  Google Scholar 

  19. Soh NYT, Chia DKA, Teo NZ, Ong CJM, Wijaya R (2018) Prevalence of colorectal cancer in acute uncomplicated diverticulitis and the role of the interval colonoscopy. Int J Colorectal Dis 33:991–994

    Article  Google Scholar 

  20. Bolkenstein HE, van de Wall BJ, Consten EC, van der Palen J, Broeders IA, Draaisma WA (2018) Development and validation of a diagnostic prediction model distinguishing complicated from uncomplicated diverticulitis. Scand J Gastroenterol 53:1291–1297. https://doi.org/10.1080/00365521.2018.1517188

    Article  PubMed  Google Scholar 

  21. Suhardja TS, Norhadi S, Seah EZ, Rodgers-Wilson S (2017) Is early colonoscopy after CT-diagnosed diverticulitis still necessary? Int J Colorectal Dis 32:485–489

    Article  Google Scholar 

  22. Koo CH, Chang JHE, Syn NL, Wee IJY, Mathew R (2020) Systematic review and meta-analysis on colorectal cancer findings on colonic evaluation after ct-confirmed acute diverticulitis. Dis Colon Rectum 63:701–709

    Article  Google Scholar 

  23. 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 54:1265–70

    Article  CAS  Google Scholar 

  24. Brar MS, Roxin G, Yaffe PB, Stanger J, MacLean AR, Buie WD (2013) Colonoscopy following nonoperative management of uncomplicated diverticulitis may not be warranted. Dis Colon Rectum 56:1259–64

    Article  Google Scholar 

  25. Studniarek A, Kochar K, Warner C, Eftaiha S, Naffouj S, Borsuk DJ, Mellgren A, Park JJ, Cintron J, Harrison J (2019) Findings on colonoscopy after diverticulitis: a multicenter review. Am Surg 85:1381–1385

    Article  Google Scholar 

  26. Daniels L, Ünlü Ç, de Wijkerslooth TR, Stockmann HB, Kuipers EJ, Boermeester MA, Dekker E (2015) Yield of colonoscopy after recent CT-proven uncomplicated acute diverticulitis: a comparative cohort study. Surg Endosc 29:2605–2613

    Article  Google Scholar 

  27. Nguyen HH, Bechara R, Paterson WG, Hookey LC (2018) Two-year retrospective analysis of patients undergoing direct to procedure flexible sigmoidoscopy investigation with rectal bleeding as a primary complaint. Endosc Int Open 6:E1059–E1064

    Article  Google Scholar 

  28. du Toit J, Hamilton W, Barraclough K (2006) Risk in primary care of colorectal cancer from new onset rectal bleeding: 10 year prospective study. BMJ 333:69–70

    Article  Google Scholar 

  29. Olde Bekkink M, McCowan C, Falk GA, Teljeur C, Van de Laar FA, Fahey T (2010) Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer. Br J Cancer 102:48–58

    Article  CAS  Google Scholar 

  30. Hayden SR, Brown MD (1999) Likelihood ratio: a powerful tool for incorporating the results of a diagnostic test into clinical decision making. Ann Emerg Med 33:575–580

    Article  CAS  Google Scholar 

  31. Astin M, Griffin T, Neal RD, Rose P, Hamilton W (2011) The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review. Br J Gen Pract 61:e231-43

    Article  Google Scholar 

  32. Fernández-Bañares F, Clèries R, Boadas J, Ribes J, Oliva JC, Alsius A, Sanz X, Martínez-Bauer E, Galter S, Pujals M, Pujol M, Del Pozo P, Campo R (2019) Prediction of advanced colonic neoplasm in symptomatic patients: a scoring system to prioritize colonoscopy (COLONOFIT study). BMC Cancer 19(1):734. https://doi.org/10.1186/s12885-019-5926-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Azhar N, Buchwald P, Ansari HZ (2020) Risk of colorectal cancer following CT-verified acute diverticulitis: a nationwide population-based cohort study. Colorectal Dis. https://doi.org/10.1111/codi.15073.10.1111/codi.15073

    Article  PubMed  Google Scholar 

  34. Siegel RL, Miller KD, Sauer AG, Fedewa SA, Butterly LF, Anderson JC, Cercek A, Smith RA, Jemal A (2020) Colorectal cancer statistics, 2020. CA Cancer J Clin. https://doi.org/10.3322/caac.21601

    Article  PubMed  Google Scholar 

  35. Alcantar DC, Rodríguez C, Fernández R, Kumar S, Junia C (2019) The necessity of a colonoscopy after an acute diverticulitis event in adults less than 50 years old. Cureus 11(9):e5666. https://doi.org/10.7759/cureus.5666

    Article  PubMed  PubMed Central  Google Scholar 

  36. Saraste D, Järås J, Martling A (2020) Population-based analysis of outcomes with early-age colorectal cancer. Br J Surg 107:301–309

    Article  CAS  Google Scholar 

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Acknowledgements

The authors would like to thank Ms. López Domingo for her technical assistance in locating patients after a diagnostic search in the institutional database.

Funding

None.

Author information

Author notes

  1. Carlos Cerdán Santacruz and Pablo Muriel Álvarez claim to have contributed equally to the realization of this study.

Authors and Affiliations

  1. Colorectal Surgery Unit, General Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain

    Carlos Cerdán Santacruz

  2. Colorectal Surgery Unit, General Surgery Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain

    Nuria Mestres Petit & José Enrique Sierra Grañón

  3. Liver, Biliary Tract and Pancreatic Surgery Unit, General Surgery Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain

    Pablo Muriel Álvarez & Jorge Juan Olsina Kissler

  4. General Surgery Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain

    Mireia Merichal Resina & Ana Isabel Pinillos Somalo

  5. Universidad de Lleida, Lleida, Spain

    Carlos Cerdán Santacruz, Gonzalo Roig Ferreruela, Nuria Mestres Petit & Jorge Juan Olsina Kissler

  6. Institut de Recerca Biomédica de Lleida, Experimental Surgery Department, Av. Prat de la Riba 44, 4º 5ª, Lleida, Spain

    Pablo Muriel Álvarez, Nuria Mestres Petit & Jorge Juan Olsina Kissler

Authors
  1. Carlos Cerdán Santacruz
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Correspondence to Pablo Muriel Álvarez.

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Dr Cerdán, Dr Muriel, Mr Roig, Dr Merichal, Dr Pinillos, Dr Mestres, Dr Sierra and Dr Olsina declare they have no conflicts of interest to disclose.

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Cerdán Santacruz, C., Muriel Álvarez, P., Roig Ferreruela, G. et al. Interval colonoscopy following acute diverticulitis should not be discouraged yet: results from a retrospective cohort. Surg Endosc 35, 6819–6826 (2021). https://doi.org/10.1007/s00464-020-08187-y

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