Incidence of Colorectal Cancer and Advanced Adenoma in Patients with Acute Diverticulitis

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The incidence of colorectal cancer (CRC) and advanced adenoma (AA) were examined in patients with diverticulitis, compared with patients undergoing screening colonoscopy.

CT scans from January 1, 2008 to May 1, 2013 were evaluated at the University of Pittsburgh Medical Center (UPMC) to identify those with confirmed acute diverticulitis. Subsequent surgical, colonoscopy and pathologic reports were abstracted to identify those with a diagnosis of AA and CRC. The incidence of neoplasia was compared with that reported for screening colonoscopy from a meta-analysis (N = 68,324), and from colonoscopy examinations at UPMC between 2013 and 2015 (N = 28,573).

A total of 5,167 abdominal/pelvic CT scan reports identified 978 patients with acute diverticulitis, among which 474 (48.5%) patients had undergone at least one colonoscopy or gastrointestinal surgery to April 2015. The CRC rate in patients with diverticulitis (13/474 – 2.7%), was significantly higher compared with the metaanalysis (0.8%) and UPMC (0.3%).

The AA rate (19/474, 4%), was similar to the rate in the meta-analysis (5%), but significantly lower than at UPMC (7.7%). The incidence of AA or CRC in complicated diverticulitis (10/141, 7.1%), did not differ significantly from the incidence of AA or CRC in uncomplicated diverticulitis (22/332, 6.6%).

It was concluded that CRC after diverticulitis was significantly higher than that observed at screening colonoscopy and was not limited to complicated disease. Colonoscopy is advisable after the diagnosis of diverticulitis.

Tehranian, S., Klinge, M., Saul, M., et al. “Prevalence of Colorectal Cancer and Advanced Adenoma in Patients with Acute Diverticulitis: Implications for Follow-Up Colonoscopy.” Gastrointestinal Endoscopy, 2020; Vol. 91, pp. 634-640.

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