EP.FRI.971 Is routine endoscopic evaluation of the colon necessary after an episode of acute diverticulitis?

Abstract

Abstract Aim Currently standard practice is for patients diagnosed with diverticulitis to undergo endoscopic evaluation of the colon following the acute episode. The primary aim of endoscopy is to exclude underlying malignancy which may have been undetectable on initial CT scanning. We aim to determine if endoscopic evaluation of the colon is necessary for all patients. Methods All patients with CT proven diverticulitis were included between May 2017 and July 2018. Medical records, CT and endoscopy reports of 154 consecutive patients were retrospectively reviewed. Based on the CT reports, diverticulitis was classified as either uncomplicated (colonic wall thickening, pericolic fat stranding) or complicated (perforation, abscess, generalised free air and/or fluid). Results There were 154 patients included in the study. 59% percent were male. Median age at the time of diagnosis was 56 years old. There were 114 patients with uncomplicated and 40 patients with complicated diverticulitis. 79 patients (50 flexible sigmoidoscopy, 29 colonoscopy) with uncomplicated diverticulitis and 21 patients (15 flexible sigmoidoscopy, 6 colonoscopy) with complicated diverticulitis underwent endoscopy. Of the patients that underwent endoscopy, one patient (1.3%) with uncomplicated disease and one patient (4.8%) with complicated disease were found to have colorectal cancer (both rectal). Neither of these were associated with the diverticular segment. Conclusions Our data shows that routine endoscopic evaluation of the colon after an episode of acute diverticulitis may not be necessary in all cases. Patient numbers in this study are small therefore further work is required to draw conclusions which could influence future clinical practice.