Routine lower gastrointestinal endoscopy for radiographically confirmed acute diverticulitis. In whom and when is it indicated?

• Published in: Revista española de enfermedades digestivas Vol. 110; no. 9; pp. 571 - 576
• Main Authors: Seoane Urgorri, Agustín, Zaffalon, Diana, Pera Román, Miguel, Batlle García, Marc, Riu Pons, Faust, Dedeu Cusco, Josep María, Pantaleón Sánchez, Miguel, Bessa Caserras, Xavier, Barranco Priego, Luis, Álvarez-González, Marco Antonio
• Format: Journal Article
• Language: English
• Published: Spain Sociedad Espanola de Patologia Digestivas 01.09.2018; Sociedad Española de Patología Digestiva; Aran Ediciones
• Subjects: Acute Disease; Adult; Aged; CAT scans; Colonic neoplasm; Colonic Neoplasms - diagnostic imaging; Colonoscopy; Colorectal cancer; Diverticulitis; Diverticulitis - diagnostic imaging; Endoscopy; Endoscopy, Gastrointestinal - methods; Female; Gastroenterology & Hepatology; Geriatrics & Gerontology; Health aspects; Humans; Infectious Diseases; Male; Medical research; Middle Aged; Oncology; Pathology; Pharmacology & Pharmacy; Polyps; Quality indicators; Radiology, Nuclear Medicine & Medical Imaging; Retrospective Studies; Surgery; Tomography; Tomography, X-Ray Computed; Tumors; Quality indicators; Colonic neoplasm; Diverticulitis; Colonoscopy
• ISSN: 1130-0108
• DOI: 10.17235/reed.2018.5524/2018

international guidelines recommend a routine colonoscopy to rule out advanced neoplasm after an acute diverticulitis event. However, in recent years, this recommendation has been called into question following the advent of computerized tomography (CT), particularly with regard to uncomplicated diverticulitis. Furthermore, colonoscopy is associated with a risk and additional costs. to understand the diagnostic yield, quality and safety of colonoscopy in the setting of acute diverticulitis. this was a retrospective study of all patients diagnosed with acute diverticulitis via CT between 2005 and 2013, who subsequently underwent a colonoscopy. two hundred and sixteen patients diagnosed with acute diverticulitis via CT were enrolled. These included 58 cases with complicated diverticulitis (27%) and 158 with uncomplicated diverticulitis (73%). An advanced neoplasm was found in 12 patients (5.6%); 11.7% were complicated and 3.2% were uncomplicated (p = 0.02). No major complications were identified. The quality was low but improved over time; the complete procedure rate was 88%, an effective preparation was achieved in 75% and excision of polyps < 2 cm was performed in 78% of cases. The optimum colonoscopy quality cu-off was 9.5 weeks. routine colonoscopy is advisable after a complicated diverticulitis event but its recommendation is unclear with regard to uncomplicated episodes. Colonoscopy is safe even when performed early. The overall quality is low but may be optimized via a subsequent endoscopy, two months after a diverticulitis diagnosis.