Follow-up colonoscopy for diverticulitis ‘unlikely to provide benefit’ beyond CRC screening
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Key takeaways:
- Patients with diverticulitis were less likely to have colorectal cancer or advanced neoplasia vs. screening population.
- Those with complicated diverticulitis were more likely to have CRC vs. screening population.
Most patients undergoing colonoscopy after diverticulitis had low risk for colorectal cancer, except those with complicated diverticulitis, whose risk was nearly four times greater than the screening population, according to research.
“There has been a concern that colorectal cancer may be misdiagnosed as diverticulitis,” Walker D. Redd, MD, a clinical outcomes and epidemiology fellow at UNC School of Medicine, told Healio. “Patients often undergo a colonoscopy to evaluate for colorectal cancer after they recover from an episode of diverticulitis. However, based on the prior evidence, the true risk of colorectal cancer being found after diverticulitis is unclear.”
Using data from the GI Quality Improvement Consortium registry, Redd and colleagues conducted a cross-sectional study to estimate the prevalence of CRC and advanced colorectal neoplasia at colonoscopy among patients with diverticulitis vs. a screening population. They compared 4,591,921 outpatient colonoscopies performed for average-risk CRC screening and 91,993 for an indication of diverticulitis follow-up between 2012 and 2021 at 779 sites.
According to results, the prevalence of CRC and advanced colorectal neoplasia was 0.33% and 6.9%, respectively, in the screening group vs. 0.31% and 5.2% in the diverticulitis group. Patients with diverticulitis also were less likely to have CRC (adjusted OR = 0.84; 95% CI, 0.74-0.94) or advanced colorectal neoplasia (aOR = 0.7; 95% CI, 0.68-0.72).
“Overall, there was a low risk of colorectal cancer among all patients undergoing colonoscopy after an episode of diverticulitis,” Redd said. “The risk for colorectal cancer was lower in most patients with recent diverticulitis than in patients being screened.”
Among a subgroup of 22,312 patients whose only indication was follow-up diverticulitis, the prevalence was 0.17% and 4.3%, respectively, and these patients also were less likely to have CRC (aOR = 0.49; 95% CI, 0.36-0.68) or advanced colorectal neoplasia (aOR = 0.59; 95% CI, 0.56-0.63) compared with the screening group.
“However, the specific group of patients who recently had an episode of complicated diverticulitis had almost four times the risk for CRC compared to the screening population,” Redd noted.
Among 421 patients with complicated diverticulitis, prevalence increased to 1.43% and 8.1% as did the likelihood of CRC (aOR = 3.57; 95% CI, 1.59-8.01) compared with the screening group. Conversely, the odds of advanced colorectal neoplasia “were similar” in the complicated diverticulitis and screening groups (aOR = 1.02; 95% CI, 0.72-1.45).
“These results inform whether providers should recommend colonoscopy after a patient recovers from an episode of diverticulitis,” Redd told Healio. “For patients with complicated diverticulitis, colonoscopy to exclude CRC is warranted and should be ordered. For most other patients with diverticulitis, colonoscopy may be unlikely to provide benefit beyond what would otherwise be recommended as part of routine CRC screening.”
He continued, “In other words, ordering a colonoscopy for patients with uncomplicated diverticulitis may be unnecessary if the patient is otherwise up-to-date with screening.”
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