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Complicated diverticulitis increases risk for colorectal cancer
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Patients with complicated diverticulitis are six times more likely to develop colorectal cancer than patients with uncomplicated diverticulitis, according to a systematic review and meta-analysis published in Clinical Gastroenterology and Hepatology.
Jeremy Meyer, MD, PhD, of the division of digestive and transplantation surgery at University Hospitals of Geneva in Switzerland, and colleagues wrote that while some experts recommend routine colonoscopy for all patients with diverticulitis, the practice has been debated because of the suspected difference in risk for CRC.
“Robust data estimating the prevalence of [CRC] in patients initially considered to have diverticulitis are needed, in order to establish whether or not these patients would benefit from diagnostic endoscopy,” they wrote. “Colonoscopy is a costly procedure, can lead to potentially lethal complications, and should therefore be reserved for patients presenting high risk for [CRC].”
Meyer and colleagues searched the literature for trials that reported the prevalence of CRC in patients with diverticulitis and found 31 studies comprising 50,445 patients.
The pooled prevalence of CRC was 1.9% (95% CI, 1.5%–2.3%). Among patients who underwent colonoscopy, investigators found the pooled prevalence of polyps (22.7%; 95% CI, 19.6%–26%), advanced adenomas (4.4%; 95% CI, 3.4%–5.8%), adenomas (14.2%; 95% CI, 11.7%–17.1%) and hyperplastic polyps (9.2%; 95% CI, 7.6%–11.2%).
Meyer and colleagues found that patients with complicated diverticulitis had a significantly higher risk for CRC (prevalence = 7.9%; 95% CI, 3.9%–15.3%) than patients with uncomplicated diverticulitis (prevalence = 1.3%; 95% CI, 0.1%–2%).
“Patients with complicated diverticulitis are more than 6-fold more likely to have [CRC] than patients with uncomplicated diverticulitis,” the researchers wrote. “We suppose that the prevalence of [CRC] is clinically relevant in patients with diverticulitis, and higher than the prevalence documented in both screened and general populations.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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