Analysis of the outcomes of postdiverticulitis investigations: a multicentre cohort study including 1,120 patients

TL;DR

This study found that endoscopic exams after uncomplicated diverticulitis rarely detect serious issues, but are more useful after complicated cases or with suspicious symptoms.

Contribution

The study provides new evidence on the effectiveness of post-diverticulitis endoscopic investigations in detecting colorectal cancer and advanced adenomas.

Findings

Uncomplicated diverticulitis had a 0.14% incidence of colorectal cancer or advanced adenomas.

Complicated diverticulitis (Hinchey 1b and 2) had higher rates of 1.4% and 5.4%, respectively.

16.8% of patients undergoing emergency surgery for suspected perforated diverticulitis had colonic malignancy.

Abstract

The aim of this study was to assess the yield of the endoscopic investigations performed following the resolution of acute diverticulitis.

A retrospective multicentre study included patients with multislice computed tomography (MSCT)-proven diverticulitis, in four NHS hospitals, between January 2016 and April 2023. The primary outcome was the rate of colonic cancer in the diseased segment. Secondary outcomes included the rate of malignancy in the nondiseased colonic segments, the benign colonic polyp detection rate, the rate of malignancy in the resected surgical specimens in patients who underwent an emergency surgery on the index admission and the rate of complications in the investigated group.

A total of 1,120 patients were included in the study, out of which 604 were females, with a median age of 61 years; 731 patients (65%) had uncomplicated diverticulitis (Hinchey 1A) while 389 (35%) had complicated diverticulitis (Hinchey 1B-4). Following the acute episode, 757 (74%) patients had subsequent endoscopic evaluation. The incidence of colorectal cancer (CRC) or advanced adenomas (AA) in patients with uncomplicated diverticulitis was 0.14%. In the complicated diverticulitis group, the incidence of CRC/AA in patients with Hinchey 1b and Hinchey 2 was 1.4% and 5.4%, respectively. Out of the 107 patients who underwent emergency colonic resection for suspected perforated diverticulitis, 18 (16.8%) had histological evidence of colonic malignancy.

Endoscopic investigations following uncomplicated diverticulitis have a low yield for sinister colonic pathology. Colonoscopy should be planned following complicated diverticulitis and in patients with uncomplicated diverticulitis with suspicious radiological finding on index imaging or in patients with ongoing clinical manifestations. In patients who undergo emergency surgery, oncological principles should be applied whenever possible.

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