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Can endoscopic follow-up after acute diverticulitis be rationalised?
Harry Frederick Dean1, Emily Britton2, Emily Farrow2
1Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK. harry.dean1@nhs.net.
Surgical Endoscopy
|March 18, 2023
Summary
Colorectal cancer (CRC) is rarely found in acute diverticulitis (AD) patients. A conservative follow-up strategy appears safe, potentially reducing unnecessary endoscopies for mild AD cases.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Colorectal Surgery
Background:
- Acute diverticulitis (AD) is a frequent surgical emergency.
- Endoscopic follow-up to rule out colorectal cancer (CRC) after AD is debated.
- Current guidelines lean towards selective follow-up based on disease severity and patient age.
Purpose of the Study:
- To determine the prevalence of CRC in patients with AD.
- To evaluate the impact of endoscopic follow-up strategies on CRC detection.
- To assess the effect of follow-up protocols on endoscopy service workload.
Main Methods:
- Observational study of patients admitted with AD over two years.
- Recorded rates of endoscopic follow-up and CRC detection.
- Evaluated the potential impact of a conservative follow-up approach.
Main Results:
- CRC was found in 1.0% of patients undergoing endoscopic follow-up and 3.6% of those with resected specimens.
- No significant difference in CRC prevalence between complicated and uncomplicated AD, or between surgically managed and conservatively managed patients.
- CRC masquerading as AD was rare, with a low incidence of neoplasia.
Conclusions:
- Conservative follow-up for AD appears safe, with a low incidence of CRC.
- Current age-based recommendations may limit the effectiveness of selective follow-up in reducing endoscopy burden.
- Restricting follow-up to complicated AD cases could decrease investigations by 70%.
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