Long-term Follow-up After an Initial Episode of Diverticulitis: A 13-Year Update

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Epidemiology

Background:

• The decision for elective sigmoid colectomy in patients with recurrent diverticulitis remains unclear.
• Current guidelines emphasize individualized surgeon-patient decision-making.
• Predicting long-term recurrence risk is essential for guiding treatment strategies.

Purpose of the Study:

• To assess the long-term incidence and risk of diverticulitis recurrence after an initial episode.
• To identify predictors associated with recurrent diverticulitis.
• To inform clinical decision-making regarding elective colectomy.

Main Methods:

• Retrospective case series analysis of 753 patients with first-time CT-proven diverticulitis.
• Data collected via medical record review and questionnaires over a median follow-up of 13.2 years.
• Multivariate analysis used to determine predictors of recurrence.

Main Results:

• Over 50% (52.4%) of patients experienced recurrent diverticulitis, with a median time to recurrence of 2.9 years.
• Key predictors of recurrence included female sex, sigmoid disease, smoldering disease, longer involved segment (>5 cm), and larger fat stranding diameter (>1.8 cm).
• Kaplan-Meier estimates showed recurrence-free rates of 73.1% at 1 year, 47.9% at 5 years, and 34.6% at 10 years.

Conclusions:

• The long-term incidence of diverticulitis recurrence after a single episode is substantial (>50%).
• Specific clinical and imaging factors are associated with an increased risk of recurrence.
• These findings are critical for patient counseling and shared decision-making for elective sigmoid colectomy.