CC BY 4.0 · Endoscopy
DOI: 10.1055/a-2587-4966
Innovations and brief communications

Endoscopic direct diverticulitis therapy for acute uncomplicated diverticulitis

Jian-Zhen Ren
1   Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
,
Jun Cai
1   Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
,
Bo Li
1   Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
,
Guang Yang
1   Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
,
Su-Huan Liao
1   Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
,
Jia-Kuan Chen
2   Department of Radiology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
,
Yi-Tian Guo
1   Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
,
Yang-Bor Lu
3   Department of Digestive Disease, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
4   Endoscopy Center, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
,
Si-Lin Huang
1   Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
› Institutsangaben

Gefördert durch: The Clinical Teaching Base Teaching Reform Research Project of School of Medicine in Shenzhen University YXBJG202426


Abstract

Background

The global prevalence of acute uncomplicated diverticulitis is increasing, and patient care for this condition is experiencing a paradigm shift. This study evaluated the diagnostic and therapeutic value of endoscopic direct diverticulitis therapy (EDDT) using cholangioscope-assisted colonoscopy for acute uncomplicated diverticulitis.

Methods

Patients with computed tomography-confirmed acute uncomplicated diverticulitis (Hinchey stage Ia or Ib) who underwent EDDT between July 2023 and December 2024 were included. The technical success rate of EDDT, procedure time, endoscopic findings, symptom resolution, and recurrence were documented.

Results

12 patients (mean age 45.2 [SD 10.1] years, 10 males) underwent EDDT. Technical success was achieved in all 12 patients (100%). Cholangioscope-assisted colonoscopy revealed fecaliths with pus in seven patients, copious purulent collection in four, edematous inflammatory mucosa in five, and bleeding in one. Corresponding treatments were applied without complications. Abdominal pain resolved immediately after EDDT, and inflammatory parameters returned to normal. No recurrences were reported over a mean follow-up of 4 months (range 1–10 months).

Conclusions

EDDT utilizing cholangioscope-assisted colonoscopy was a feasible alternative treatment for acute uncomplicated diverticulitis, offering diagnostic and therapeutic advantages through direct visualization. Although preliminary results are promising, further studies with larger cohorts are warranted to confirm its efficacy and long-term outcomes.



Publikationsverlauf

Eingereicht: 14. Januar 2025

Angenommen nach Revision: 11. April 2025

Accepted Manuscript online:
15. April 2025

Artikel online veröffentlicht:
14. Mai 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 
  • References

  • 1 Bharucha AE, Parthasarathy G, Ditah I. et al. Temporal trends in the incidence and natural history of diverticulitis: a population-based study. Am J Gastroenterol 2015; 110: 1589-1596
  • 2 Stollman N, Smalley W, Hirano I. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology 2015; 149: 1944-1949
  • 3 van Dijk ST, Daniels L, Ünlü Ç. et al. Long-term effects of omitting antibiotics in uncomplicated acute diverticulitis. Am J Gastroenterol 2018; 113: 1045-1052
  • 4 de Korte N, Kuyvenhoven JP, van der Peet DL. et al. Mild colonic diverticulitis can be treated without antibiotics. A case-control study. Colorectal Dis 2012; 14: 325-330
  • 5 Cai J, Huang S, Lu Y. et al. First report of the use of a digital single-operator cholangioscope for endoscopic direct diverticulitis therapy. Endoscopy 2024; 56: E466-e467
  • 6 Daniels L, Ünlü Ç, de Korte N. et al. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg 2017; 104: 52-61
  • 7 Broersen LHA, Horváth-Puhó E, Pereira AM. et al. Corticosteroid use and mortality risk in patients with perforated colonic diverticular disease: a population-based cohort study. BMJ Open Gastroenterol 2017; 4: e000136
  • 8 Strate LL, Morris AM. Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology 2019; 156: 1282-1298.e1281
  • 9 Humes DJ, Spiller RC. Review article: the pathogenesis and management of acute colonic diverticulitis. Aliment Pharmacol Ther 2014; 39: 359-370
  • 10 Boermeester MA, Humes DJ, Velmahos GC. et al. Contemporary review of risk-stratified management in acute uncomplicated and complicated diverticulitis. World J Surg 2016; 40: 2537-2545
  • 11 Ren J, Huang S, Cai J. et al. Endoscopic direct therapy for appendicitis and diverticulitis in one patient with right-sided abdominal pain. Endoscopy 2024; 56: E687-e688
  • 12 Lorenzo-Zúñiga V. Commentary. Endoscopy 2024; 56: 803-803
  • 13 Peery AF, Shaukat A, Strate LL. AGA Clinical practice update on medical management of colonic diverticulitis: expert review. Gastroenterology 2021; 160: 906-911.e901
  • 14 Sartelli M, Weber DG, Kluger Y. et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg 2020; 15: 32
  • 15 Galetin T, Galetin A, Vestweber KH. et al. Systematic review and comparison of national and international guidelines on diverticular disease. Int J Colorectal Dis 2018; 33: 261-272
  • 16 Schultz JK, Azhar N, Binda GA. et al. European Society of Coloproctology: guidelines for the management of diverticular disease of the colon. Colorectal Dis 2020; 22: 5-28
  • 17 Sakhnini E, Lahat A, Melzer E. et al. Early colonoscopy in patients with acute diverticulitis: results of a prospective pilot study. Endoscopy 2004; 36: 504-507
  • 18 Lahat A, Yanai H, Menachem Y. et al. The feasibility and risk of early colonoscopy in acute diverticulitis: a prospective controlled study. Endoscopy 2007; 39: 521-524
  • 19 Simonetti S, Lanciotti S, Carlomagno D. et al. Acute diverticulitis: beyond the diagnosis: predictive role of CT in assessing risk of recurrence and clinical implications in non-operative management of acute diverticulitis. Radiol Med 2024; 129: 1118-1129
  • 20 Lin D, Su M, Su Y. et al. Digital single-operator cholangioscope-assisted endoscopic retrograde appendicitis therapy in the management of Crohn’s disease with acute appendicitis. Endoscopy 2024; 56: E791-e792