SHOULD WE RECOMMEND THE PERFORMANCE OF ROUTINE COLONOSCOPIES AFTER ANY EPISODE OF ACUTE DIVERTICULITIS?

Aims The incidence of acute diverticulitis (AD) is rising because of the progressive ageing of the population. Follow-up colonoscopies are usually performed to exclude concomitant colorrectal cancer (CRC). However, recent publications indicate that their real benefit may not compensate for their potential risks. Our aim was to assess if performing colonoscopies to all patients suffering from an AD would improve the CRC detection.

Methods We carried out a descriptive and retrospective study. We reviewed the clinical history of patients who presented with AD from June/2018 to December/2018.

Results 60 (77%) of the 77 patients included presented a non-complicated AD. 18% had a complicated course being abdominal abscess the most frequent complication. The diagnosis was achieved through a CT-scan in all cases. 45% of patients underwent a colonoscopy from 1 to 3 months after the AD. 9 patients (12%) had a normal colonoscopy in the last 5 years. Only one patient (1.3%), who presented with complicated AD and suggestive malignant findings on CT-scan, was diagnosed with CRC.

Table 1

Gender	Woman	42 (55%)
Age (average)	64.2 years (±13.07 years)
Family or personal history of CRC	No	77 (100%)
CT-SCAN findings	Acute diverticulitis	76 (99%)
	Abscess	7 (9%)
	Fistula	2 (3%)
	Perforation	4 (5%)
	Colonic wall>5cm	1(1%)
	Pelvis mass	1 (1%)
	Lymphadenopathy	2 (3%)
	Abdominal liquid	11 (15%)
	Obstruction	1(1%)
Follow-up colonoscopy findings	Diverticulum	44 (100%)
	Estenosis	1(1%)
	Polyps	22 (55%)
	Colorrectal cáncer	0 (0%)

Conclusions We conclude that the recommendation of performing a routine colonoscopy after any episode of AD is not justified. This thinking comes from the time where the diagnosis of AD was achieved by an opaque enema, which has a low sensibility and specificity to discard CRC. Nowadays the implementation of enhanced CT-scan leads to a reliable diagnosis with a low rate of misleading CRC. In the presence of CRC risk factors, alarm symptoms, AD complicated presentation or malignant findings on CT-scan, the performance of a colonoscopy becomes essential.

Publication History

Article published online:
14 April 2022