Colonoscopy After Diverticulitis - Does It Really Increase the Chance of Detecting Colon Cancer?
Colonoscopy is recommended after sigmoid diverticulitis, as anecdotal reports have suggested and increased risk of colorectal cancer (CRC).
In this study the authors identified 4,591,921 outpatient colonoscopies performed for screening and 91,993 colonoscopies for diverticulitis follow-up (1).
CRC prevalence was 0.33% in colonoscopies for screening and 0.31% in colonoscopies for diverticulitis.
Interestingly, compared to screening, patients with diverticulitis were LESS likely to have CRC (adjusted OR 0.84, 95% CI 0.74-0.94).
More puzzlingly, CRC prevalence decreased to 0.17% in colonoscopies performed for diverticulitis only. Compared to screening, patients with diverticulitis as the only indication were less likely to have CRC (adjusted OR 0.49, 95% CI 0.36-0.68) (1).
However, CRC prevalence increased to 1.43% in patients with complicated diverticulitis. Compared to screening, patients with complicated diverticulitis were more likely to have CRC (adjusted OR 3.57, 95% CI 1.59-8.01) (1)
The authors concluded that “The risk of CRC cancer is low in most patients with diverticulitis. Patients with complicated diverticulitis are the exception.”
Therefore, colonoscopy to detect missed CRC should include diverticulitis patients with a complication and those not current with CRC screening (1).
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Reference:
1. Redd WD, Holub JL, Nichols HB, Sandler RS, Peery AF. Follow-up Colonoscopy for Detection of Missed Colorectal Cancer after Diverticulitis. Clin Gastroenterol Hepatol. 2024 Apr 24:S1542-3565(24)00393-8. doi: 10.1016/j.cgh.2024.03.036. Epub ahead of print. PMID: 38670477.
https://pubmed.ncbi.nlm.nih.gov/38670477/