Routine Endoscopy After Acute Sigmoid Diverticulitis: Would a Sigmoidoscopy be Sufficient?

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Diagnostic Endoscopy

Background:

• Current guidelines recommend colonoscopy post-acute diverticulitis to exclude colorectal cancer (CRC).
• The sigmoid colon is the primary focus after acute sigmoid diverticulitis.

Purpose of the Study:

• To evaluate flexible sigmoidoscopy (FS) as a potential alternative to full colonoscopy.
• To assess the efficacy of FS in detecting colorectal cancer (CRC) and polyps after acute sigmoid diverticulitis.

Main Methods:

• Retrospective analysis of 271 patients diagnosed with acute sigmoid diverticulitis via CT.
• Review of medical records, CT, endoscopy, and histopathology reports.

Main Results:

• Diverticulosis confirmed in all patients; no colorectal malignancies detected.
• Adenomatous polyps found in 5.9% of patients, with only 1.1% beyond the sigmoid colon.
• Polyp detection rate comparable to the general population.

Conclusions:

• CRC detection is rare after acute sigmoid diverticulitis, even with full colonoscopy.
• Flexible sigmoidoscopy (FS) is a feasible alternative for malignancy screening in the sigmoid colon.
• FS offers patient and healthcare advantages: quicker, cheaper, safer, with less preparation and sedation.