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Colonoscopy follow-up for acute diverticulitis: a multi-centre review
Brodie D Laurie1, Mary M K Teoh2, Alfredo Noches-Garcia3
1Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia. Brodie.Laurie1@gmail.com.
Surgical Endoscopy
|October 11, 2022
Summary
Routine colonoscopy after uncomplicated diverticulitis is not cost-effective for colorectal cancer screening in patients over 50. Consider the National Bowel Cancer Screening Program (NBCSP) with fecal occult blood testing (FOBT) instead.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Oncology
Background:
- Diverticulitis is a common condition requiring management.
- Current practice involves routine colonoscopy 6-8 weeks post-acute diverticulitis.
- The value of this routine colonoscopy is questioned.
Purpose of the Study:
- To investigate the diagnostic yield of routine colonoscopy following computed tomography (CT) confirmed diverticulitis.
- To assess the cost-effectiveness of routine colonoscopy for colorectal cancer (CRC) screening in diverticulitis patients.
- To compare outcomes between uncomplicated and complicated diverticulitis cases.
Main Methods:
- Retrospective cohort study of 1680 adult patients with acute diverticulitis (uncomplicated n=1005, complicated n=675) between 2017-2019.
- Comparison with 1800 positive cases from the National Bowel Cancer Screening Program (NBCSP).
- Data analyzed using SPSS v.27.
Main Results:
- 1272 patients underwent follow-up colonoscopy.
- Colorectal cancer (CRC) incidence was similar across groups: uncomplicated diverticulitis (1.0%), complicated diverticulitis (2.1%), and NBCSP (1.9%).
- A significantly higher rate of negative colonoscopies was observed in uncomplicated diverticulitis patients over 50.
Conclusions:
- Routine colonoscopy is not a cost-effective CRC screening strategy for patients over 50 with uncomplicated diverticulitis.
- Recommend NBCSP with biennial fecal occult blood testing (FOBT) for this demographic.
- Continue routine colonoscopy for uncomplicated diverticulitis patients under 50 and all complicated diverticulitis patients.
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