Abstract
Background: Current guidelines suggest that patients should undergo colonoscopy after CT confirmed acute diverticulitis to outrule colorectal cancer (CRC). The aim of this study was to determine if flexible sigmoidoscopy (FS) could be a viable alternative to full colonoscopy following acute sigmoid diverticulitis.Methods: A retrospective study of 271 patients was performed who were diagnosed with acute sigmoid diverticulitis by CT and subsequently underwent full colonoscopy. Medical records, CT reports, endoscopy reports, and histopathological reports were reviewed.Results: Sigmoid diverticulosis was confirmed on colonoscopy in all patients. No colorectal malignancies were detected. Adenomatous polyps were found in 16 (5.9%) patients, of which three had polyps detected beyond the sigmoid colon. The overall proportion of abnormalities found beyond the sigmoid colon was 1.1% (n=3).Conclusion: The detection of CRC cancer in patients undergoing full colonoscopy following an episode of acute sigmoid diverticulitis is rare. Despite this, current guidelines still advocate for endoscopy due to the potentially serious consequences of a missed malignancy. However, given that the area of concern in these cases is the sigmoid colon, FS may be a feasible means of outruling malignancy in the absence of red flag features that would necessitate a full colonoscopy. Our results support this approach, with no CRC detected and a polyp detection rate equivalent to that of the general population. This offers numerous advantages to a full colonoscopy for the patient and health service by being a quicker, cheaper, safer procedure without the need for full bowel preparation or IV sedation.
Highlights
Acute diverticulitis is common in Western countries and its incidence has been steadily increasing over the past century [1]
A retrospective observational cohort study of patients diagnosed with acute sigmoid diverticulitis by CT that were treated by conservative management and subsequently underwent follow-up colonoscopy in a public teaching hospital was performed over a three-year period
While there is no evidence to suggest that patients with diverticular disease are at an increased risk of colorectal cancer (CRC), the historically overlapping features of acute sigmoid diverticulitis and sigmoid malignancy on CT scan have previously made the exclusion of CRC on cross-sectional imaging alone difficult [12]
Summary
Acute diverticulitis is common in Western countries and its incidence has been steadily increasing over the past century [1]. The risk of developing colonic diverticulosis in industrialized countries is approximately 60%, with up to 25% of those going on to suffer at least one episode of acute diverticulitis in their lifetime [2]. There is some overlap in the radiological features of acute diverticulitis and colorectal cancer (CRC) [4] For this reason, professional societies such as the American Society of Colon and Rectal Surgeons (ASCRS) and the American College of Gastroenterology (ACG) recommend that patients undergo colonoscopy four to six weeks after an episode of acute diverticulitis to exclude malignancy [5,6]. The aim of this study was to determine if flexible sigmoidoscopy (FS) could be a viable alternative to full colonoscopy following acute sigmoid diverticulitis
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