The feasibility and risk of early colonoscopy in acute diverticulitis: a prospective controlled study

Background and study aim: Following acute diverticulitis, colonoscopy is advised to rule out malignancy. Commonly, the colonoscopy is postponed to avoid the potential risk of perforation. In a previous pilot, noncontrolled study, we showed that early colonoscopy is feasible in patients with acute diverticulitis. This randomized controlled trial compared early and late colonoscopy in hospitalized patients with acute diverticulitis.

Patients and methods: 154 patients diagnosed with acute diverticulitis were hospitalized between January 2004 and June 2006. Of these, 35 patients were excluded because of either free perforation or pericolic air on computed tomography (CT), and another 18 because they had undergone colonoscopy in the previous year. The remaining 101 patients were offered the possibility of participating in the study, with random allocation to either early in-hospital colonoscopy or late colonoscopy, 6 weeks later. Randomization was refused by 15 patients, and 86 were included in the study.

Results: 45 patients were randomly allocated for early colonoscopy and 41 for late colonoscopy. Three and 10 did not present for the examination, in the early and late group respectively. The cecum could not be reached in eight and three patients from the early and late groups, respectively. The colonoscopy revealed polyps in five patients, two in the early group and three in the late group. No malignancy was detected. There were no complications in either group.

Conclusions: Early colonoscopy in acute diverticulitis is feasible and safe in the absence of pericolic air on CT, and has greater compliance. However, no added value is apparent compared with the CT scan currently used.

References

• 1 Hulnick D H, Megibow A J, Baithazar E J. et al . Computed tomography in the evaluation of diverticulitis.  Radiology. 1984;  152 491-495
• 2 Kaiser A M, Jiang J K, Lake J P. et al . The management of complicated diverticulitis and the role of Computed Tomography.  Am J Gastroenterol. 2005;  100 910-917
• 3 Hachigian M P, Honickman S, Eisenstat T E. et al . Computed tomography in the initial management of acute left sided diverticulitis.  Dis Colon Rectum. 1992;  35 1123-1129
• 4 Almy T P, Howell D A. Diverticular disease of the colon.  N Engl J Med. 1980;  302 324-331
• 5 Penfold J CB. Perforation of the colon complicating colonoscopy: report of a case.  Dis Colon Rectum. 1975;  18 626-627
• 6 Forde K A. Colonoscopy in complicated diverticular disease.  Gastrointest Endosc. 1977;  23 192-193
• 7 Dean A CG, Newell J P. Colonoscopy in the differential diagnosis of carcinoma from diverticulitis of the sigmoid colon.  Br J Surg. 1973;  60 633-635
• 8 Panish J F. Limitations and complications of colonoscopy.  Gastrointest Endosc. 1980;  26 20s-21s
• 9 Sakhnini E, Lahat A, Melzer E. et al . Early colonoscopy in patients with acute diverticulitis: results of a prospective pilot study.  Endoscopy. 2004;  36 504-507
• 10 Waye J D, Bashkoff E. Total colonoscopy: is it always possible?.  Gastrointest Endosc. 1991;  37 152-154
• 11 Marshall J B, Barthel J S. The frequency of total colonoscopy and terminal ileal intubation in the 1990s.  Gastrointest Endosc. 1993;  39 518-520
• 12 Lieberman D A, Smith F W. Screening for colon malignancy with colonoscopy.  Am J Gastroenterol. 1991;  86 946-951
• 13 Rex D K, Lehman G A, Hawes R H. et al . Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests.  Gastroenterology. 1991;  100 64-67
• 14 Johnson D A, Gurney M S, Volpe R J. et al . A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk.  Am J Gastroenterol. 1990;  85 969-974
• 15 DiSario J A, Foutch P G, Mai H D. Prevalence and malignant potential of colorectal polyps in asymptomatic average-risk men.  Am J Gastroenterol. 1991;  86 941-945
• 16 Villavicencio R T, Rex D K. Colonic adenomas: prevalence and incidence rates, growth rates, and miss rates at colonoscopy.  Semin Gastrointest Dis. 2000;  11 185-193
• 17 Lieberman D A, Weiss D G, Bond J H. et al . Use of colonoscopy to screen asymptomatic adults for colorectal cancer.  N Engl J Med. 2000;  343 162-168
• 18 Shahmir M, Schuman B M. Complications of fiberioptic endoscopy.  Gastroinest Endosc. 1980;  26 86-91
• 19 Muhldorfer S M, Kekos G, Hahn E G. et al . Complications of therapeutic gastrointestinal endoscopy.  Endoscopy. 1992;  24 276-283