Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2019; 11(7): 427-437
Published online Jul 16, 2019. doi: 10.4253/wjge.v11.i7.427
Should a colonoscopy be offered routinely to patients with CT proven acute diverticulitis? A retrospective cohort study and meta-analysis of best available evidence
Peter Asaad, Shahab Hajibandeh, Mariam Rahm, Theo Johnston, Supria Chowdhury, Christine Bronder
Peter Asaad, Department of General Surgery, Stepping Hill Hospital, Stockport SK2 7JE, United Kingdom
Shahab Hajibandeh, Department of General Surgery, North Manchester General Hospital, Manchester M8 5RB, United Kingdom
Mariam Rahm, Theo Johnston, Supria Chowdhury, Christine Bronder, Department of General and Colorectal Surgery, Royal Lancaster Infirmary, Lancaster LA1 4RP, United Kingdom
Author contributions: Asaad P and Hajibandeh S designed the research study; Rahm M, Johnston T, and Chowdhury S collected the data for the cohort study; Asaad P and Hajibandeh S collected the data for the meta-analysis; Asaad P and Hajibandeh S analysed and interpreted the data; Asaad P and Hajibaneh S did the statistical analysis; Asaad P and Hajibandeh S wrote the article; All authors critically revised the article; All authors provided final approval for the article.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Peter Asaad, BM, MRCS, MSc, Doctor, Surgeon, Department of General Surgery, Stepping Hill Hospital, Stockport SK2 7JE, United Kingdom. p_asaad01@hotmail.com
Telephone: +07702168765
Received: May 7, 2019
Peer-review started: May 10, 2019
First decision: May 31, 2019
Revised: June 7, 2019
Accepted: June 20, 2019
Article in press: June 21, 2019
Published online: July 16, 2019
Abstract
BACKGROUND

The current guidelines suggest that patients should undergo endoscopic evaluation of the colonic lumen after an episode of computed tomography (CT) proven acute diverticulitis to rule out malignancy. The usefulness of routine endoscopic evaluation of CT proven diverticulitis remains unknown.

AIM

To establish whether routine colonoscopy should be offered to patients after an episode of diverticulitis.

METHODS

We performed a retrospective study, comparing two groups: a diverticulitis group and a control group. The diverticulitis group consisted of patients undergoing a colonoscopy after an episode of diverticulitis. The control group consisted of asymptomatic patients undergoing a screening sigmoidoscopy. We also performed a systematic review and meta-analysis. We searched electronic data resources to identify all relevant studies. The primary outcome was the number of adenomas found, while the secondary outcomes were the number of cancers and polyps identified, and the adenoma risk.

RESULTS

68 and 1309 patients were included in the diverticulitis and control groups respectively. There was no difference in the risk of adenomas (5.9% vs 7.6%, P = 0.59), non-advanced adenomas (5.9% vs 6.9%, P = 0.75), advanced adenomas (0% vs 0.8%, P = 1), cancer (0% vs 0.15%, P = 1.00), and polyps (16.2% vs 14.2%, P = 0.65) between both groups. Meta-analysis of data from 4 retrospective observational studies, enrolling 4459 patients, showed no difference between the groups in terms of risk of adenomas (RD = -0.05, 95%CI: -0.11, 0.01, P = 0.10), non-advanced adenomas (RD = -0.02, 95%CI: -0.08, 0.04, P = 0.44), advanced adenomas (RD = -0.01, 95%CI: -0.04, 0.02, P = 0.36), cancer (RD = 0.01, 95%CI: -0.01, 0.03, P = 0.32), and polyps (RD = -0.05, 95%CI: -0.12, 0.02, P = 0.18).

CONCLUSION

Routine colonoscopy may not be appropriate in patients with acute diverticulitis. High quality prospective studies are required for more robust conclusions.

Keywords: Diverticulitis, Colon cancer, Screening, Colonoscopy, Sigmoidoscopy

Core tip: The results of this study suggest that patients with computed tomography (CT)-proven acute diverticulitis are not at increased risk of colonic adenomas and neoplastic lesions as indicated by comparable endoscopic findings to general populations undergoing screening endoscopy. This suggests that endoscopic evaluation of colon may not be beneficial in cases with CT-proven acute diverticulitis and could be preserved for selected cases only. Our results are consistent with the best available evidence in the literature. However, the best available evidence is derived from a limited number of retrospective studies with moderate quality. High quality prospective studies are required for definite conclusions.