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Colonoscopy after nonoperative management of uncomplicated diverticulitis may not be warranted

November's issue of the Diseases of the Colon & Rectum determined the diagnostic yield of endoscopy for clinically significant neoplasia following the successful nonoperative management of acute diverticulitis.

News image

Following the nonoperative management of acute diverticulitis, guidelines recommend routine follow-up colonoscopy.

However, evidence to support this recommendation are lacking.

Dr Mantaj Brar and colleagues determined the diagnostic yield of endoscopy for clinically significant neoplasia following the successful nonoperative management of acute diverticulitis.

The team performed a retrospective review in a large urban health region.

Adult patients who were admitted with a diagnosis of acute diverticulitis confirmed by CT, and who were successfully managed nonoperatively to hospital discharge were included.

Patients who underwent colonoscopy within 2 years of presentation were excluded.

The team's main outcome was the incidence of clinically significant neoplasia on follow-up endoscopy within 1 year of admission.

9% of patients were found to have clinically significant neoplasia
Diseases of the Colon & Rectum

The research team selected 480 patients for analysis, of which 249 patients underwent endoscopy within 1 year of admission.

The team found that 31% of patients had polyps, 7% had advanced adenomas, and 2% had an invasive malignancy.

The team observed that 9% of patients were found to have clinically significant neoplasia.

On subgroup analysis, patients presenting with complicated diverticulitis had a significantly higher incidence of advanced adenoma and invasive malignancy in comparison with patients who presented with uncomplicated diverticulitis.

The researchers found that, patient age and the presence of abscess were identified as significant risk factors for clinically significant neoplasia.

Dr Brar's team concludes, "The incidence of clinically significant neoplasia on endoscopic follow-up after the nonoperative management of acute diverticulitis is 9%."

"Those with complicated diverticulitis are at higher risk, whereas the incidence of clinically significant neoplasia in those with uncomplicated diverticulitis is equal to the incidence in average-risk individuals."

"Routine diagnostic colonoscopy following the nonoperative management of acute uncomplicated diverticulitis may not be warranted."

Dis Colon Rectum 2013: 56(11): 1259–1264
12 November 2013

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