Avery S Walker1, Jason R Bingham2, Karmon M Janssen2, Eric K Johnson2, Justin A Maykel3, Omar Ocampo4, John P Gonzalez5, Scott R Steele2. 1. Department of Surgery, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, USA. Electronic address: averyw21@gmail.com. 2. Department of Surgery, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, USA. 3. Department of Colon and Rectal Surgery, UMass Memorial Medical Center, Worcester, MA, USA. 4. Department of Surgery, FEU NRMF Medical Center, West Fairview, Quezon City, Philippines. 5. Department of Surgery, Visayas Community Medical Center, Cebu City, Central Visayas, Philippines.
Abstract
BACKGROUND: Modern 64- to 128-slice computed tomography (CT) scanners have questioned the need for routine colonoscopy after hospital admission for presumed uncomplicated diverticulitis. METHODS: This is a retrospective review of all patients (>18 years) who underwent planned colonoscopy after admission for Hinchey I or II acute diverticulitis (January 2009 to January 2014). The findings on the final radiologist report were then correlated with the colonoscopy results. RESULTS: In total, 110 patients (mean age, 55.2 ± 16; 46.4% female) underwent a subsequent colonoscopy (median, 60 days) after admission for diverticulitis. Overall, 102 patients (92.7%) had CT findings consistent with definitive diverticulitis, 6 patients had a diagnosis suggestive of diverticulitis on CT scan, and 2 patients had masses on their admission CT scans. Within the group with definitive diverticulitis, follow-up colonoscopy identified diverticulosis in 99 (97.0%), whereas the other 3 had normal findings. Of the patients with CT scans suggestive of diverticulitis, follow-up colonoscopy showed 3 with diverticulosis, 2 with malignancies, and 1 with nonspecific inflammation. The reliability of CT scans for diverticulitis compared with colonoscopy was found to have a kappa = .829 (P < .001; 95% confidence interval, .629, 1.21). CONCLUSIONS: Follow-up colonoscopy should be performed when a CT scan suggests malignancy, nonspecific inflammatory findings, or the patient is otherwise due for routine screening or surveillance. In this study, there was no benefit of follow-up colonoscopy in patients with CT-confirmed diverticulitis in the absence of other concerning or indeterminate findings. Published by Elsevier Inc.
BACKGROUND: Modern 64- to 128-slice computed tomography (CT) scanners have questioned the need for routine colonoscopy after hospital admission for presumed uncomplicated diverticulitis. METHODS: This is a retrospective review of all patients (>18 years) who underwent planned colonoscopy after admission for Hinchey I or II acute diverticulitis (January 2009 to January 2014). The findings on the final radiologist report were then correlated with the colonoscopy results. RESULTS: In total, 110 patients (mean age, 55.2 ± 16; 46.4% female) underwent a subsequent colonoscopy (median, 60 days) after admission for diverticulitis. Overall, 102 patients (92.7%) had CT findings consistent with definitive diverticulitis, 6 patients had a diagnosis suggestive of diverticulitis on CT scan, and 2 patients had masses on their admission CT scans. Within the group with definitive diverticulitis, follow-up colonoscopy identified diverticulosis in 99 (97.0%), whereas the other 3 had normal findings. Of the patients with CT scans suggestive of diverticulitis, follow-up colonoscopy showed 3 with diverticulosis, 2 with malignancies, and 1 with nonspecific inflammation. The reliability of CT scans for diverticulitis compared with colonoscopy was found to have a kappa = .829 (P < .001; 95% confidence interval, .629, 1.21). CONCLUSIONS: Follow-up colonoscopy should be performed when a CT scan suggests malignancy, nonspecific inflammatory findings, or the patient is otherwise due for routine screening or surveillance. In this study, there was no benefit of follow-up colonoscopy in patients with CT-confirmed diverticulitis in the absence of other concerning or indeterminate findings. Published by Elsevier Inc.
Authors: Jeancarlos Jhosmer Trujillo Díaz; Beatriz De Andrés Asenjo; María Ruiz Soriano; Carlos Jezieniecki Fernández; Javier Ortiz de Solórzano Aurusa; Juan Pablo Beltrán de Heredia Rentería Journal: Ann Gastroenterol Date: 2019-11-29