Comparison of colonoscopy after colonic diverticulitis and positive fecal immunochemical tests for the detection of colorectal neoplasia

Abstract

Background and study aims The relationship between acute colonic diverticulitis and colorectal cancer (CRC) is unclear, but colonoscopy is recommended to exclude malignancy. We compared the detection rates for colorectal neoplasia in patients with colonic diverticulitis and asymptomatic patients who had positive fecal immunochemical tests (FITs).

Patients and methods In total, 282 patients with acute colonic diverticulitis were hospitalized in our hospital from February 2011 to December 2019. Of them, 143 patients with diverticulitis and 1819 with positive FITs patients during the same period underwent colonoscopy without a prior colonoscopy within 5 years. We retrospectively compared these patients in terms of the invasive CRC rate, advanced neoplasia detection rate (ANDR), adenoma detection rate (ADR), and polyp detection rate (PDR).

Results Compared to the diverticulitis group, the FIT-positive group had a significantly higher CRC rate (0 vs 2.7 %, P = 0.0061), ANDR (5.6 vs. 14.0 %, P = 0.0017), ADR (19.6 vs. 53.2 %, P < .0001), and PDR (44.1 vs. 91.0 %, P < .0001). Using 1:1 propensity score matching based on age and sex, we obtained 276 matched patients in both groups. After matching, no difference was found in the CRC rate (0 vs 0.7 %) or ANDR (5.8 vs 7.3 %) between groups, but the ADR and PDR were significantly higher in the FIT-positive group (20.3 vs 43.5 %, P < .0001; 45.7 % vs 86.2 %, P < .0001).

Conclusion Patients with acute diverticulitis had lower ADRs and PDRs than patients with positive FITs.

Publication History

Received: 30 June 2020

Accepted: 02 November 2020

Article published online:
18 February 2021

• References

• 1 Stollman N, Smalley W, Hirano I. et al. American Gastroenterological Association Institute Guideline on the Management of Acute Diverticulitis. Gastroenterology 2015; 149: 1944-1949
• 2 Strate LL, Peery AF, Neumann I. American Gastroenterological Association Institute Technical Review on the Management of Acute Diverticulitis. Gastroenterology 2015; 149: 1950-1976, e1912
• 3 Nagata N, Ishii N, Manabe N. et al. Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association. Digestion 2019; 99 (Suppl. 01) 1-26
• 4 Daniels L, Unlu C, de Wijkerslooth TR. et al. Routine colonoscopy after left-sided acute uncomplicated diverticulitis: a systematic review. Gastrointest Endosc 2014; 79: 378-389 ; quiz 498–498 e375
• 5 Granlund J, Svensson T, Granath F. et al. Diverticular disease and the risk of colon cancer – a population-based case-control study. Aliment Pharmacol Therap 2011; 34: 675-681
• 6 Tanaka S, Kashida H, Saito Y. et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Digest Endosc 2015; 27: 417-434
• 7 Lai EJ, Calderwood AH, Doros G. et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69: 620-625
• 8 Lieberman DA, Weiss DG, Bond JH. et al. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med 2000; 343: 162-168
• 9 Amano T, Nishida T, Shimakoshi H. et al. Number of polyps detected is a useful indicator of quality of clinical colonoscopy. Endosc Int Open 2018; 6: E878-E884
• 10 Zaman S, Chapman W, Mohammed I. et al. Patients with computed tomography-proven acute diverticulitis require follow-up to exclude colorectal cancer. Intest Res 2017; 15: 195-202
• 11 Choi YH, Koh SJ, Kim JW. et al. Do we need colonoscopy following acute diverticulitis detected on computed tomography to exclude colorectal malignancy?. Digest Dis Sci 2014; 59: 2236-2242
• 12 Lecleire S, Nahon S, Alatawi A. et al. Diagnostic impact of routine colonoscopy following acute diverticulitis: A multicenter study in 808 patients and controls. United Europ Gastroenterol J 2014; 2: 301-306
• 13 Hardcastle JD, Chamberlain JO, Robinson MH. et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996; 348: 1472-1477
• 14 Mandel JS, Bond JH, Church TR. et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993; 328: 1365-1371
• 15 Kronborg O, Fenger C, Olsen J. et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996; 348: 1467-1471
• 16 Mandel JS, Church TR, Bond JH. et al. The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med 2000; 343: 1603-1607
• 17 Chan DKH, Tan KK. There Is no role for colonoscopy after diverticulitis among Asian patients less than 50 years of age. Gastrointest Tumors 2017; 3: 136-140
• 18 Urabe M, Nishida T, Shimakoshi H. et al. Distinct Clinical factors in hospitalized patients with diverticular bleeding and diverticulitis. Digestion 2019; 99: 239-246
• 19 Saito H. Screening for colorectal cancer by immunochemical fecal occult blood testing. Jpn J Cancer Res 1996; 87: 1011-1024