Intest Res  
Patients with computed tomography-proven acute diverticulitis require follow-up to exclude colorectal cancer
Shafquat Zaman1, Warren Chapman2, Imtiyaz Mohammed3, Kathryn Gill1, Stephen Thomas Ward4
1Department of General Surgery, Sandwell & West Birmingham Hospitals NHS Trust, Sandwell General Hospital, West Bromwich, 2Nurse Consultant and Clinical Lead for Endoscopy at City Hospital Endoscopy Unit, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham City Hospital, Birmingham, 3Department of Gastroenterology, Sandwell & West Birmingham Hospitals NHS Trust, Sandwell General Hospital, West Bromwich, 4Department of General Surgery, University Hospitals Coventry & Warwickshire NHS Trust, Walsgrave , UK
Correspondence to: Stephen Thomas Ward, Department of General Surgery, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Walsgrave, West Midlands CV3 2DX, UK. Tel: +44-2476-966102, Fax: +44-2476-966090, E-mail: stephen.ward7@nhs.net
Received: August 16, 2016; Revised: October 21, 2016; Published online: March 17, 2017.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims: Traditionally, patients with acute diverticulitis undergo follow-up endoscopy to exclude colorectal cancer (CRC). However, its usefulness has been debated in this era of high-resolution computed tomography (CT) diagnosis. We assessed the frequency and outcome of endoscopic follow-up for patients with CT-proven acute diverticulitis, according to the confidence in the CT diagnosis. Methods: Records of patients with CT-proven acute diverticulitis between October 2007 and March 2014 at Sandwell & West Birmingham Hospitals NHS Trust were retrieved. The National Cancer Registry confirmed the cases of CRC. Endoscopy quality indicators were compared between these patients and other patients undergoing the same endoscopic examination over the same period. Results: We identified 235 patients with CT-proven acute diverticulitis, of which, 187 were managed conservatively. The CT report was confident of the diagnosis of acute diverticulitis in 75% cases. Five of the 235 patients were subsequently diagnosed with CRC (2.1%). Three cases of CRC were detected in the 187 patients managed conservatively (1.6%). Forty-eight percent of the conservatively managed patients underwent follow-up endoscopy; one case of CRC was identified. Endoscopies were often incomplete and caused more discomfort for patients with diverticulitis compared with controls. Conclusions: CRC was diagnosed in patients with CT-proven diverticulitis at a higher rate than in screened asymptomatic populations, necessitating follow-up. CT reports contained statements regarding diagnostic uncertainty in 25% cases, associated with an increased risk of CRC. Follow-up endoscopy in patients with CT-proven diverticulitis is associated with increased discomfort and high rates of incompletion. The use of other follow-up modalities should be considered.
Keywords: Diverticulitis; Follow-up; Endoscopy; Colorectal neoplasms


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