Is Colonoscopy Necessary After Acute Diverticulitis?

Probably not, especially in patients who have already undergone a colonoscopy in recent years.

Some experts recommend that patients with acute diverticulitis undergo colonoscopy 4 to 6 weeks after healing to exclude malignancy as an underlying cause. However, some study findings have cast doubt on the need for colonoscopy in this setting.

In the current systematic review, investigators estimated the prevalences of colorectal cancer and advanced adenomas detected by colonoscopy after acute diverticulitis. In all studies, diverticulitis was documented by radiographic imaging, and computed tomographic imaging did not suggest the presence of cancer.

In eight studies comprising 1796 patients, the pooled prevalence of colorectal cancer was 1.5%, the pooled prevalence of advanced adenomas was 3.8%, and the adenoma detection rate was 14%.

Comment

The authors concluded that these data do not provide clear support for performance of colonoscopy after acute uncomplicated diverticulitis. However, the prevalence of 1.5% for colorectal cancer would be high for a screening study. The decision regarding performance of colonoscopy should probably be individualized. Certainly, in a patient of screening age who has not had a previous colonoscopy, it would be reasonable to perform one. What this study does not address (and which seems generally unnecessary) is repeat colonoscopy in patients with simple acute uncomplicated diverticulitis who have already undergone examinations in the past few years. This issue should be further investigated.

Reviewing Author

Douglas K. Rex, MD

Disclosures

Consultant/Advisory BoardOlympus Corporation America; Boston Scientific

Speaker’s BureauOlympus

Grant/Research SupportMedtronic; Boston Scientific; Colonary Solutions; Paion Medical; Medivators; Braintree Laboratories

Editorial BoardsWorld Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology; GI Journal Watch; Austin Journal of Gastroenterology; World Journal of Gastrointestinal Pharmacology & Therapeutics

Leadership Positions in Professional SocietiesAmerican Society for Gastrointestinal Endoscopy (Treasurer); US Multi-Society Task Force (AGA, ACG, ASGE) (Chair)