Analysis of the outcomes of post-diverticulitis investigations, A multicentre cohort study including 1052 patients

Abstract

Abstract Aim: This is the largest single study, to date, which aims to assess the yield of the endoscopic investigations performed following acute diverticulitis. Method: A retrospective multi-centre study included patients with multislice computed tomography (MSCT) proven diverticulitis, in three NHS hospitals, between January 2016 and December 2022. The primary outcome was the rate of colonic cancer in the diseased segment. Secondary outcomes included the rate of malignancy in the non-diseased colonic segments, the benign colonic polyp detection rate, the rate of malignancy in the resected surgical specimens in patients who underwent an emergency surgery on the index admission and the rate of complications in the investigated group. Results: 1052 patients were included in the study; out of which 680 (64.6%) were females with median age of 65 (21-91) years. 694 patients (66%) had uncomplicated diverticulitis (Hinchey stage 1A) while 358 (39%) had complicated diverticulitis (Hinchey stage 1B - 4). Following the acute episode, 715 (68%) patients had subsequent endoscopic evaluation. The incidence of colorectal cancer (CRC) or advanced adenomas (AA) in patients with uncomplicated (Hinchey 1A) diverticulitis was 0.14%. The incidence of CRC/AA in patients with Hinchey 1b and Hinchey 2 was 1.4 % and 4.4% respectively. 18/98 patients (18.4%) out of the patients who underwent emergency colonic resection for suspected perforated diverticulitis had histological evidence of colonic malignancy. Conclusion: Colonoscopy following uncomplicated diverticulitis has a low yield. It should be reserved for patients with complicated diverticulitis and those with uncomplicated diverticulitis who have suspicious radiological or clinical manifestations. In patients who undergo emergency surgery, oncological principles should be applied whenever possible.