Evaluation of follow-up colonoscopy in acute colonic diverticulitis for detection of advanced adenoma and colon cancer: a retrospective cohort study.

BACKGROUND: Due to variable rates of colon carcinoma or advanced adenoma mimicking an acute diverticulitis episode, the necessity of colonoscopy to detect colon cancer or advanced adenoma remains to be explored. This study investigated the incidence and predictive factors of colon cancer or advanced adenoma following acute diverticulitis.
METHODS: We evaluated retrospectively all consecutive patients with an episode of computed tomography-proven acute diverticulitis between June 2016 and August 2019. A follow-up colonoscopy was performed. Demographic and clinical parameters were recorded. Patients with clinically substantial colonic neoplasia (colon cancer or advanced adenoma) were classified as Group A, while Group B included patients without clinically significant colonic neoplasia. The incidence of clinically significant colonic neoplasia in acute diverticulitis patients was regarded as the primary outcome.
RESULTS: The mean age of 233 patients with acute diverticulitis was 58.6 ± 12.7 years. Complicated diverticulitis was detected in 39 patients (16.7 %). Sixteen patients (6.9 %) were assigned to Group A and 217 patients (93.1 %) to Group B. The age of the patients in group A was significantly higher than in Group B (p =0.001). Age above 50 and 65 years was also significantly associated with clinically significant colonic neoplasia (p =0.015 and p =0.012, respectively). The other variables did not influence the development of clinically significant colonic neoplasia (p >0.05).
CONCLUSIONS: Colonoscopy examination following an episode of acute diverticulitis may not be recommended for all patients due to the rare occurrence of colon cancer or clinically significant colonic neoplasia in those younger than 50 years. HIPPOKRATIA 2021, 25 (2):69-74. Copyright 2021, Hippokratio General Hospital of Thessaloniki.