Uncomplicated diverticulitis boasts lower colorectal cancer risk than routine screening
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Key takeaways:
- Colorectal cancer risk was lower in patients with uncomplicated diverticulitis vs. those undergoing routine screening.
- Patients with complicated diverticulitis remain at significantly increased risk for CRC.
VANCOUVER, British Columbia — The risk for colorectal cancer was lower among patients undergoing colonoscopy for diverticulitis compared with routine cancer screening, according to a presenter at the ACG Annual Scientific Meeting.
“Diagnosing diverticulitis can be difficult, and there has been concern that colorectal cancer could be misdiagnosed as diverticulitis,” Walker D. Redd, MD, from the University of North Carolina School of Medicine, told Healio. “It is often recommended that patients undergo a colonoscopy to exclude a colorectal cancer following an episode of diverticulitis, but this is a controversial recommendation based on limited evidence.”
To determine the prevalence and relative risk of identifying adenocarcinoma and advanced neoplasia on colonoscopy in patients with a diverticulitis indication vs. those undergoing routine CRC screening, Redd and colleagues conducted a study of patients in the GI Quality Improvement Consortium registry who underwent outpatient colonoscopy for a diverticulitis indication (n = 91,993) or standard risk screening (n = 4,591,921) from January 1, 2012, to December 31, 2021.
The study’s primary outcome was prevalence of adenocarcinoma on colonoscopy and a secondary outcome of advanced neoplasia, including advanced adenoma, advanced serrated lesion and adenocarcinoma. The researchers used logistic regression to assess the link between a diverticulitis indication and primary/secondary outcomes, with models adjusted for confounding variables.
According to study results, the prevalence of adenocarcinoma and advanced neoplasia was lower among patients with uncomplicated diverticulitis (0.17%; 4.3%) compared with patients who received routine screening (0.33%; 6.9%); patients with uncomplicated diverticulitis also were less likely to exhibit adenocarcinoma (adjusted OR = 0.49; 95% CI, 0.36-0.68) vs. those undergoing routine screening.
“We found that the risk of colorectal cancer is low in most patients undergoing colonoscopy for an indication of diverticulitis,” Redd noted. “The risk of colorectal cancer in most of these patients was lower compared to the risk of colorectal cancer in patients undergoing routine screening.”
However, among patients with diverticulitis complicated by abscess or perforation, the researchers reported an adenocarcinoma prevalence of 1.43% and advanced neoplasia prevalence of 8.1%. According to Redd, patients with complicated diverticulitis “had almost four times the risk of colorectal cancer compared to the screening population” (aOR = 3.57; 95% CI, 1.59-8.01).
“Patients with complicated diverticulitis should undergo colonoscopy to exclude missed colorectal cancer, but colonoscopy is unlikely to provide benefit beyond routine colorectal cancer screening for most patients with diverticulitis,” Redd told Healio.
He added: “Future studies should use different sources of data to compare the risk of colorectal cancer between patients undergoing colonoscopy for diverticulitis and patients undergoing screening colonoscopy. It would be helpful to use a data source that contains information on prior colonoscopy results and/or details about the diverticulitis diagnosis. There may also be a role for prospective studies to follow patients after their initial diverticulitis diagnosis.”
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Redd WD, et al. Prevalence of colon cancer in patients undergoing colonoscopy with a diverticulitis indication compared to a screening population. Presented at: ACG Annual Scientific Meeting; Oct. 20-25, 2023; Vancouver, British Columbia (hybrid meeting).
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