Colonoscopy After Diverticulitis Usually Unnecessary

Most patients with diverticulitis have a low risk of colorectal cancer (CRC), according to a study published in Clinical Gastroenterology and Hepatology.

“Colonoscopy often is recommended after an episode of diverticulitis to exclude missed CRC. This is a controversial recommendation based on limited evidence,” wrote corresponding author Anne F. Peery, MD, of the University of North Carolina School of Medicine, Chapel Hill, North Carolina, and study coauthors.

To investigate whether follow-up colonoscopy is warranted for CRC detection after diverticulitis, researchers looked at the prevalence and odds of CRC across 91,993 colonoscopies performed for diverticulitis follow-up compared with nearly 4.6 million outpatient colonoscopies performed for CRC screening. Data for the study was from the Gastrointestinal Quality Improvement Consortium registry.

The prevalence of CRC was 0.31% in colonoscopies for diverticulitis and 0.33% in colonoscopies for screening, according to the study. Patients with diverticulitis were less likely to have CRC, with an adjusted odds ratio of 0.84 compared with patients who received screening colonoscopies.c

In colonoscopies performed solely for diverticulitis, the CRC prevalence was just 0.17%, the study found. Patients with diverticulitis as the only colonoscopy indication had an adjusted odds ratio of 0.49 for CRC compared with patients who received screening.

“Patients with complicated diverticulitis,” researchers added, “are the exception.”

In patients with complicated diverticulitis, the prevalence of CRC was 1.43% and the adjusted odds ratio for CRC was 3.57 compared with patients who received CRC screening.

“Our results suggest that colonoscopy to detect missed CRC should include diverticulitis patients with a complication and those not current with CRC screening,” researchers concluded.

Reference

Redd WD, Holub JL, Nichols HB, Sandler RS, Peery AF. Follow-up colonoscopy for detection of missed colorectal cancer after diverticulitis. Clin Gastroenterol Hepatol. 2024;22(10):2125-2133. doi:10.1016/j.cgh.2024.03.036