Rethinking the role of endoscopy for colorectal cancer following diverticulitis: An exploratory model for guiding...

The association between diverticulitis and colorectal (CRC) remains controversial, with current guidelines differing significantly in terms of post-diverticulitis endoscopic assessment. This study is aimed at developing an exploratory model to identify patients at high risk of CRC following diverticulitis.

This retrospective cohort study analyzed 1546 patients diagnosed with diverticulitis between January 2021 and December 2023 at a UK tertiary care hospital. Ordinal logistic regression was used to identify predictors associated with CRC risk.

Of 1546 patients, the mean age was 69.2 years SD ± 12.9, and 51.5 % were female. Increasing age (OR 1.28 per SD, 95 % CI 1.14-1.45, p < 0.001) and male sex (OR 1.75, 95 % CI 1.39-2.21, p < 0.001) were high risk predictors associated with increased risk of CRC. Conversely, abdominal pain (OR 0.60, 95 % CI 0.44-0.80, p = 0.001) and per-rectal bleeding (OR 0.71, 95 % CI 0.56-0.89, p = 0.004), and presence of diverticulosis showed a protective association (OR 0.68, 95 % CI 0.47-0.97, p = 0.033), which could be due to confounding. CT findings did not achieve statistical significance as independent predictors in the multivariable model.

This exploratory model identifies patient characteristics that stratify CRC risk following diverticulitis. These findings may help personalize decisions regarding post-diverticulitis colonoscopy, optimizing resource allocation while maintaining appropriate cancer surveillance. However, this model would require external validation before use in clinical practice.