COLONOSCOPY AFTER ACUTE DIVERTICULITIS: TIME TO CHANGE RECOMMENDATIONS?

Aims The findings of unincreased rate of colorectal cancer in diverticulosis patients along with recent reports doubting the benefit of prompt colonoscopy after acute episode of diverticulitis mandates further evaluation of colonoscopy yield and timing in this regard. The current study aims to determine wither the rate of advanced colonic neoplasia after acute diverticulitis differs from that of average risk patients, and to identify risk factors associated with their development.

Methods In this retrospective study, all patients hospitalized to surgery ward in the years 2008-2016 with radiographically confirmed acute diverticulitis and completed colonoscopies within 1 year of index hospitalization were included. Patients referred for screening colonoscopy in the same years were included as a control group. We compared the rate of colorectal cancer and advanced polyp diagnosis rates between both groups before and after adjustment for age, sex and colonoscopy preparation quality. Moreover, we investigated risk factors associated with increased rate of advanced polyp and cancer diagnosis.

Results 350 patients were included in the diverticulitis group and 1502 patients in the screening colonoscopy control group. Colorectal cancer diagnosis rate (1.2% vs. 0.3%; p=0.09) as well as overall diagnosis of advanced neoplasia (12.3% vs. 9.6%; p=0.19) were not significantly different when comparing findings from AD and control groups, respectively. Complicated diverticulitis was associated with increased risk of advanced neoplasia diagnosis (OR 3.729, 95% CI 1.803-7.713; P=0.01).

Conclusions Advanced neoplasia diagnosis rate in colonoscopies performed after acute diverticulitis appears to be similar to that of average risk populations. Complicated diverticulitis course, however, may confer a prominently increased risk for its diagnosis and may justify early follow-up colonoscopy. Large scale prospective studies to further define the impact of a risk-matched approach is warranted.