FP3.5 - Colonoscopy post diverticulitis – Compliance with ACPGBI guidance in a single centre audit

Abstract

Abstract Introduction For decades the management of acute diverticulitis (AD) has included endoscopic evaluation to exclude malignancy. In complicated AD, the incidence of colonic neoplasia is between 7.8%-10.9% (1-5) so interval colonoscopy remains mandatory. However, in uncomplicated AD, the incidence is low, 1.6%-1.9% (1-5), therefore the routine colonoscopy may be unnecessary in this group. This audit aims to assess our single-centre compliance with the ACPGBI guidance of colonoscopy post-diverticulitis. Methods A retrospective single-centre audit enrolled 120 patients with CT-confirmed diverticulitis over 18 months. Patient identification involved on-call handover sheets or PACS reports containing "diverticulitis" or "complicated diverticular disease." Patient scans were reviewed, and their management was studied. Results Number Number Uncomplicated Surgery 0 (Hinchey 1A+1B) No surgery 90 (75%) Colonoscopy 71 (59%) No colonoscopy 19 (16%) Surgery 15 (12.5%) Complicated (Hinchey 2 or greater) No surgery 15 (12.5%) Colonoscopy 11 (9.2%) No colonoscopy 4 (3.3%) Total 120 3.3% of complicated diverticulitis did not undergo colonoscopy due to patient choice, comorbidities or frailty. Among the 82 patients who underwent colonoscopy, there was no detection of CRC, resulting in a 0% detection rate. Conclusion In this 120-patient cohort, the incidence of colorectal cancer was 0%, which is in keeping with the published data. 78.9% of patients with uncomplicated diverticulitis underwent colonoscopy, which may have been unnecessary. The use of faecal immunochemical testing may be beneficial as an adjunct to avoid endoscopy in this group, whilst taking into consideration individual risk factors such as age, clinical suspicion of malignancy or concerning features on imaging.