SP9.1.6 Save the scope - a 3-year analysis of follow-up methods for acute diverticulitis and the incidence of colorectal malignancy

Abstract

Abstract Aims Previously, guidelines for the management of diverticular disease have recommended endoscopic evaluation following acute diverticulitis to exclude colorectal cancer (CRC). However, 2021 ACPGBI consensus guidelines recognised the sensitivity of modern CT scanning and low incidence of CRC, and suggested no routine re-imaging in CT-proven uncomplicated disease. Methods Patient were identified presenting between 2017–2019 at a single centre. Records were retrospectively reviewed to evaluate the incidence of CRC at a minimum of 18-month follow up in this patient group. Secondary outcomes included the imaging method requested, operative management, and complications following endoscopy. Results Of 486 admissions in 461 patients, 168 (35%) had CT-proven complicated disease, 225 (46%) had uncomplicated, and 93 (19%) had no imaging. 281 (59%) had follow-up investigations requested; 126 CT colonoscopy (CTC) and 150 endoscopic. 133 investigations were performed in patients with uncomplicated diverticulitis. Only 6 patients (1%) were diagnosed with CRC; 2 at endoscopy, and 4 by histology from colorectal resections during emergency admission; all had CT-proven complicated diverticulitis. No malignancy was identified in patients with uncomplicated diverticulitis. Secondary outcomes identified that 26 (24%) flexible sigmoidoscopies were poorly tolerated, necessitating further imaging. Conclusions At our centre, there was little consensus on whether patients had follow-up imaging following acute diverticulitis, and what modality was used. We identified no CRC in patients with CT-proven uncomplicated disease, with 133 potentially unnecessary investigations performed in this group. We recommend use of CTC or endoscopy following acute CT-proven complicated diverticulitis in line with ACPGBI guidelines, avoiding follow-up in uncomplicated disease.