Year 2018 / Volume 110 / Number 9
Original
Routine lower gastrointestinal endoscopy for radiographically confirmed acute diverticulitis. In whom and when is it indicated?

571-576

DOI: 10.17235/reed.2018.5524/2018

Agustín Seoane Urgorri, Diana Zaffalon, Miguel Pera Román, Marc Batlle García, Faust Riu Pons, Josep María Dedeu Cusco, Miguel Pantaleón Sánchez, Xavier Bessa Caserras, Luis Barranco Priego, Marco Antonio Álvarez-González,

Abstract
Introduction: 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. Objective: to understand the diagnostic yield, quality and safety of colonoscopy in the setting of acute diverticulitis. Methods: this was a retrospective study of all patients diagnosed with acute diverticulitis via CT between 2005 and 2013, who subsequently underwent a colonoscopy. Results: 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. Conclusion: 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.
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References
1. Warner E, Crighton EJ, Moineddin R, et al. Fourteen-year study of hospital admissions for diverticular disease in Ontario. Can J Gastroenterology. 2007;21(2):97-99.
2. Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive disease in the united states. Gastroenterology 2002;122(5):1500-11.
3. Brar MS, Roxin G, Yaffe PB et al. Colonoscopy following nonoperative management of uncomplicated diverticulitis may not be warranted. Dis Colon Rectum. 2013;56(11):1259-64.
4. Daniels L, Unlü C, de Wijkerslooth TR, et al. Routine colonoscopy after left-sided acute uncomplicated diverticulitis: a systematic review. GastrointestEndosc. 2014;79(3):378-389.
5. de Vries HS, Boerma D, Timmer R, et al. Routine colonoscopy is not required in uncomplicated diverticulitis: a systematic review. Surg Endos 2014;28(7): 2039-2047.
6. Sharma PV, Eglinton T, Hilder P, et al. Systematic review and Meta-analysis of the role of routine colonic evaluation after radiologically confirmed acute diverticulitis. Annals of Surgery 2014;259(2):263-272.
7. Rafferty J, Shellito P, Hyman NH, et al. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006;49(7):939-944.
8. Andersen JC, Bundgaard L, Elbrond H, et al. Danish national guidelines for treatment of diverticular disease. Dan Med J. 2012;59:C4453.
9. Peppas G, Bliziotis IA, Oikonomaki D, et al. Outcomes after medical and surgical treatment of diverticulitis: a systematic review of the available evidence. J Gastroenterol Hepatol. 2007;22(9):1360-1368.
10. Janes S, Meagher A, Frizelle FA. Elective surgery after acute diverticulitis. Br J Surg. 2005;92:133-142.
11. Destigter KK, Keating DP. Imaging update: acute colonic diverticulitis. Clin Colon Rectal Surg. 2009;22:147-155.
12. Sallinen V, Mentula P, Leppäniemi A. Risk of colon cáncer after computed tomography-diagnosed acute diverticulitis. Is routine colonoscopy necessary?. Surg Endosc 2014;28(3):961-966.
13. Dean AC, Newell JP. Colonoscopy in the differential diagnosis of carcinoma from diverticulitis of the sigmoid colon. Br J Surg 1973; 60(8):633-635
14. Panish JF. Limitations and complications of colonoscopy. Gastrointest Endosc 1980; 26(2 Suppl):20S-21S.
15. Guía práctica de calidad en la colonoscopia de cribado de cáncer colorrectal. Asociación Española de Gastroenterología y Sociedad Española de Endoscopia Digestiva. Edimsa; 2011. p. 29-55.
16. Lahat A, Yanai H, Menachem Y, et al. The feasibility and risk of early colonoscopy in acute diverticulitis: a prospective controlled study. Endoscopy 2007; 39(6): 521-524
17. Sai VF, Velayos F, Neuhaus J, et al. Colonoscopy after TC Diagnosis of Diverticulitis to exclude colon cancer: A Systematic Literature Review. Radiology 2012; 263(2):383-390.
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Seoane Urgorri A, Zaffalon D, Pera Román M, Batlle García M, Riu Pons F, Dedeu Cusco J, et all. Routine lower gastrointestinal endoscopy for radiographically confirmed acute diverticulitis. In whom and when is it indicated?. 5524/2018


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Publication history

Received: 06/02/2018

Accepted: 16/04/2018

Online First: 14/06/2018

Published: 31/08/2018

Article revision time: 66 days

Article Online First time: 128 days

Article editing time: 206 days


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