Risk of colon cancer after acute uncomplicated diverticulitis: Is routine colonoscopy necessary?

Abstract

Background & Aims: It has long been recommended that patients undergo follow up colonoscopy to exclude colon cancer after an episode of acute diverticulitis. The role of colonoscopy following an episode of acute uncomplicated diverticulitis remains controversial. Our aim was to evaluate the need for colonoscopy after an episode of acute uncomplicated diverticulitis, diagnosed both clinically and by Computed tomography scan (CT). Methodology: We performed a retrospective case review of patients with first presentation of acute uncomplicated diverticulitis over a six year period at two centres: Royal Derby Hospital, Derby, UK; and St. James's University Hospital, Ireland Results: A total of 5461 were admitted with a primary diagnosis of acute diverticulitis In 110 patients (2.29%) a histological diagnosis of colonic malignancy was made. The yield of colonic neoplasia at any stage in our study was equivalent to that detected by screening programmes in asymptomatic individuals among an international standards (0.8-1.1%) and comparable to the estimated prevalence of 1.4% among adults older than 65 years Conclusion: The incidence of colorectal cancer in patients presenting with acute diverticulitis was low at 2.29%. Unless colonoscopy is part of a screening programme routine colonoscopy following an episode of CT-diagnosed acute uncomplicated diverticulitis is unnecessary in the absence of other alarming clinical signs of colorectal cancer. We suggest that this group of patients may suitable for protocolized symptom-driven follow-up shared with primary care.