Does Colonic Diverticulosis Impact Adenomatous Polyp Detection Rate in Average Risk Screening Colonoscopy?

Abstract

Purpose: To determine if the anatomic variant of colonic diverticulosis has a negative impact on left-sided adenomatous polyp detection rates. Methods: Retrospective review of patients undergoing average-risk screening colonoscopy at two hospitals and one ambulatory surgical center over a three month period. Patient demographics, prep quality, polyp number, size, and location, as well as severe diverticulosis size and location were recorded. Severe diverticulosis was defined as multiple small and large mouth diverticulosis present in the left colon. While a majority (80%) of the colonoscopies were performed by gastroenterologists, surgeons accounted for the remaining 20%. Patients between the ages of 50 and 90 years of age were included for review. Left-sided adenomatous polyps were included in the analysis. Sessile serrated adenomas were considered equivalent to adenomas for this study. Adenoma detection rate (ADR) was calculated by dividing the number of procedures in which one or more adenomas are detected by the total number of procedures. Results: A total of 1,080 [male: 490, mean age ± standard deviation (SD): 58.6 ± 7.3 years] patients satisfi ed study criteria. A total of 411 patients [male: 191, mean age ± SD: 60.8 ± 7.8 years) were reported to have colonic severe diverticulosis. Among the 1,080 patients, left-sided adenomatous polyps were found in 148 (14%) patients. There was no significant difference in left-sided ADR in patients with severe diverticulosis versus patients without (51 vs. 97, p = 0.33) and total colonic ADR (127 vs. 176, p = 0.10). There was no difference for left-sided polyps ≤ 5 mm in size (diverticulosis with vs. without: 37 vs. 67, p = 0.58). There was no difference in reported prep quality (excellent/good vs. fair/poor) in patients with severe diverticulosis versus without (81 vs. 118, p = 0.54). Left-sided ADR was higher in men vs. women (89 vs. 59, p < 0.001) and the difference was significant irrespective of colonic diverticulosis. Conclusion: Despite the anatomic distortion often seen with severe colonic diverticulosis, there is not a significant difference in prep quality or adenomatous polyp detection rate. Larger studies must be undertaken to validate above conclusions.