Yield of Post-acute Diverticulitis Colonoscopy for Ruling out Colorectal Cancer

• Published in: Techniques and innovations in gastrointestinal endoscopy Vol. 24; no. 3; pp. 254 - 261
• Main Authors: Azizian, John M., Trieu, Harry, Kovacs, Thomas O., Turkiewicz, Joanna, Hilder, Robin, Palmer, Samantha, Roux, Michelle Le, Dong, Tien, Berry, Rani, Beaven, Simon W., Tabibian, James H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2022
• Subjects: Adenocarcinoma; Adenoma detection; Colonoscopy; Diverticular disease; Fecal immunochemical test; Adenocarcinoma; Diverticular disease; FIT; AD; CRC; Colonoscopy; Adenoma detection; Fecal immunochemical test; adenocarcinoma; fecal immunochemical test (FIT); adenoma detection; diverticular disease; colonoscopy
• ISSN: 2590-0307; 2666-5107; 2590-0307
• DOI: 10.1016/j.tige.2022.04.001

Colonoscopy is recommended for post-acute diverticulitis (AD) to exclude underlying colorectal cancer (CRC). However, post-AD colonoscopy utility remains controversial. We aimed to examine yield of post-AD colonoscopy in our predominately Hispanic patient population. Patients undergoing post-AD colonoscopy between November 1, 2015 and July 31, 2021 were identified from a prospectively maintained endoscopic database. AD cases without computed tomography confirmation were excluded. Pertinent data were abstracted, including whether patients had complicated or uncomplicated AD; fecal immunochemical test (FIT) result post-AD and precolonoscopy; number, type, and location of nonadvanced adenomas; advanced adenomas; and CRC. Analyses were conducted using 2-sample Wilcoxon rank sum and Fisher exact tests. Two hundred eight patients were included, of whom 62.0% had uncomplicated AD. Median age was 53 years, 113 (54.3%) were female, and 161 (77.4%) were Hispanic. Ninety nonadvanced adenomas were detected in 45 patients (21.6%), in addition to eight advanced adenomas in 8 patients (3.8%). Two patients (1.0%) had CRC, both of whom had complicated AD in the same location seen on imaging, and 1 of whom was FIT positive (the other had not undergone FIT). Patients with uncomplicated vs complicated AD had similarly low rates of advanced adenomas (4.7% vs 2.5%, P = 0.713). FIT data were available for 51 patients and positive in 3 (5.9%); nonadvanced adenomas were found in all 3 patients who were FIT positive. No patient who was FIT negative had an advanced adenoma or CRC. Colonoscopy post-AD is generally low yield, with CRC rarely being found and only in those with complicated AD. Colonoscopy post-complicated AD appears advisable, whereas less invasive testing (eg, FIT) may be considered for post-uncomplicated AD to inform the need for colonoscopy.