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Is Colonoscopy Necessary After Acute Diverticulitis?

Summary and Comment |
April 1, 2014

Is Colonoscopy Necessary After Acute Diverticulitis?

  1. Douglas K. Rex, MD

Probably not, especially in patients who have already undergone a colonoscopy in recent years.

  1. Douglas K. Rex, MD

Some experts recommend that patients with acute diverticulitis undergo colonoscopy 4 to 6 weeks after healing to exclude malignancy as an underlying cause. However, some study findings have cast doubt on the need for colonoscopy in this setting.

In the current systematic review, investigators estimated the prevalences of colorectal cancer and advanced adenomas detected by colonoscopy after acute diverticulitis. In all studies, diverticulitis was documented by radiographic imaging, and computed tomographic imaging did not suggest the presence of cancer.

In eight studies comprising 1796 patients, the pooled prevalence of colorectal cancer was 1.5%, the pooled prevalence of advanced adenomas was 3.8%, and the adenoma detection rate was 14%.

Comment

The authors concluded that these data do not provide clear support for performance of colonoscopy after acute uncomplicated diverticulitis. However, the prevalence of 1.5% for colorectal cancer would be high for a screening study. The decision regarding performance of colonoscopy should probably be individualized. Certainly, in a patient of screening age who has not had a previous colonoscopy, it would be reasonable to perform one. What this study does not address (and which seems generally unnecessary) is repeat colonoscopy in patients with simple acute uncomplicated diverticulitis who have already undergone examinations in the past few years. This issue should be further investigated.

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Given Imaging; Olympus Corporation America; Exact Sciences; Endo Aid Speaker’s bureau Boston Scientific; Braintree Laboratories; Ferring Pharmaceuticals; Olympus America Grant / research support CDC; Olympus America; Boston Medical Center Editorial boards World Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology Leadership positions in professional societies American Society for Gastrointestinal Endoscopy (Councilor); US Multi-Society Task Forces (AGA, ACG, ASGE) (Chair)

Citation(s):

Reader Comments (2)

RONNIE CYZNER Physician, Gastroenterology, Charlotte, NC

Certainly a colonoscopy is indicated, but I wouldn't be surprised if she has IBS constipation causing the abdominal pain, low back pain and feeling down the legs

john hoefen retired teacher

my wife suffered a bout of diverticulitis.She had back pain at first followed by burning in the thights and legs.nausea and weight loss.also adomen left die before the antibitics Burning pain came afteralso a tight feeling in lower backShe was put on pain killers for back pain (undiagnoised)which commplicated constipationThis is her second bout of disease.First case was very mild.
She had three cat scans but no colonoscopy yet.
She still suffers pain and nausea and generaly poor health.
any ideas on helping her/
thanks so much

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