Utility of Colonoscopy to Exclude Underlying Malignant Polyps After Resolution of Uncomplicated Diverticulitis

Abstract

intervention, or monitoring.3 After resolution of an episode of diverticulitis, the standard of care is to perform a colonoscopy to exclude diagnoses that mimic diverticulitis—notably, colorectal cancer. This recommendation arose during a time when the diagnosis rested on clinical suspicion and radio­ graphic imaging with barium.4 Computed tomog­ raphy, with a substantially higher sensitivity than barium enema5 at diagnosing cancer and other ab­ dominal pathologic conditions, is now the primary modality used to define complicated diverticulitis, with low interobserver variability and a sensitivity and specificity approaching 99%.6 Computed tomo­ graphic findings in complicated diverticulitis in­ clude abscess, fistula, stricture, extensive stranding, obstruction, or air (ie, perforation); colonic wall thickening and mass lesions are concerning radio­ logic features for neoplasia. The current Clinical Guideline Task Force of the American Society of Colon and Rectal Surgeons recommends that “after resolution of acute diverticu­ litis, perform colonoscopy in 6 to 8 weeks following resolution, to confirm diagnosis; if this is first epi­ sode or recent colonoscopy has not been done” Utility of Colonoscopy to Exclude Underlying Malignant Polyps After Resolution of Uncomplicated Diverticulitis