Evaluation of Routine Flexible Sigmoidoscopy After CT-Confirmed Acute Diverticulitis: A Retrospective Study

Acute diverticulitis is a common condition with increasing prevalence in Western countries. Current guidelines recommend endoscopic follow-up after an episode of acute diverticulitis to exclude malignancy, despite limited evidence supporting this practice. This study evaluates the utility of routine flexible sigmoidoscopy following CT-confirmed acute diverticulitis.

A retrospective cohort study was conducted at Maidstone and Tunbridge Wells NHS Trust from 2020 to 2022. We analysed 429 patients with CT-confirmed acute uncomplicated diverticulitis (Hinchey 1) who subsequently underwent flexible sigmoidoscopy six to eight weeks after initial presentation. Patient demographics, CT findings, and flexible sigmoidoscopy results were collected and analysed.

Of the 429 patients included (180 males, 249 females; mean age 64 years), none were found to have colonic malignancy on follow-up flexible sigmoidoscopy. Only three patients (0.69%) had polyps: one inflammatory, one non-specific hyperplastic, and one tubular adenoma with low-grade dysplasia.

Our findings suggest that routine flexible sigmoidoscopy following CT-confirmed acute uncomplicated diverticulitis may not be necessary. Less invasive initial investigations, such as the faecal immunochemical test (FIT), could be considered for high-risk patients, potentially reducing unnecessary endoscopic procedures, associated patient risks, and healthcare costs.