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Mortensen LQ, Andresen K, Thygesen L, Pommergaard HC, Rosenberg J. Diverticulitis Is Associated with Increased Risk of Colon Cancer-A Nationwide Register-Based Cohort Study. J Clin Med 2024; 13:2503. [PMID: 38731032 PMCID: PMC11084441 DOI: 10.3390/jcm13092503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
Background: An association between diverticulitis and colon cancer has been proposed. The evidence is conflicting, and the guidelines differ regarding recommended follow-up with colonoscopy after an episode of diverticulitis. To guide regimes for follow-up, this study aimed to investigate if patients with diverticulitis have an increased risk of colon cancer. Methods: This study is reported according to the RECORD statement. We performed a cohort study with linked data from nationwide Danish registers. The inclusion period was 1997-2009, and the complete study period was 1995-2013. The primary outcome was the risk of developing colon cancer estimated using a Cox regression analysis with time-varying covariates. We performed a sensitivity analysis on a cohort of people with prior colonoscopies, comparing the risk of colon cancer between the diverticulitis group and the control group. Results: We included 29,173 adult males and females with diverticulitis and 145,865 controls matched for sex and age. The incidence proportion of colon cancer was 2.1% (95% confidence interval (CI) 1.9-2.3) in the diverticulitis group and 1.5% (95% CI 1.4-1.5) in the matched control group (hazard ratio 1.6; 95% CI 1.5-1.8). The risk of having a colon cancer diagnosis was significantly increased in the first six months after inclusion (hazard ratio 1.7; 95% CI 1.5-1.8), and hereafter there was a lower risk in the diverticulitis group compared with controls (hazard ratio 0.8; 95% CI 0.7-0.9). This protective effect lasted eight years. The increased risk of colon cancer during the first six months after diverticulitis was also found in the cohort with prior colonoscopies. Conclusions: The risk of a colon cancer diagnosis was significantly increased for patients with diverticulitis 0-6 months after the diagnosis of diverticulitis. Hereafter, we found a protective effect of diverticulitis until eight years later, possibly due to a screening effect. We recommend a follow-up colonoscopy after the first diagnosis of diverticulitis.
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Affiliation(s)
- Laura Quitzau Mortensen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, 2730 Herlev, Denmark; (L.Q.M.)
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Amager and Hvidovre Hospital, 2650 Hvidovre, Denmark
| | - Kristoffer Andresen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, 2730 Herlev, Denmark; (L.Q.M.)
| | - Lau Thygesen
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark
| | - Hans-Christian Pommergaard
- Hepatic Malignancy Surgical Research Unit (HEPSURU), Department of Surgery and Transplantation, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, 2730 Herlev, Denmark; (L.Q.M.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Ziegelmayer S, Reischl S, Havrda H, Gawlitza J, Graf M, Lenhart N, Nehls N, Lemke T, Wilhelm D, Lohöfer F, Burian E, Neumann PA, Makowski M, Braren R. Development and Validation of a Deep Learning Algorithm to Differentiate Colon Carcinoma From Acute Diverticulitis in Computed Tomography Images. JAMA Netw Open 2023; 6:e2253370. [PMID: 36705919 DOI: 10.1001/jamanetworkopen.2022.53370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Differentiating between malignant and benign etiology in large-bowel wall thickening on computed tomography (CT) images can be a challenging task. Artificial intelligence (AI) support systems can improve the diagnostic accuracy of radiologists, as shown for a variety of imaging tasks. Improvements in diagnostic performance, in particular the reduction of false-negative findings, may be useful in patient care. OBJECTIVE To develop and evaluate a deep learning algorithm able to differentiate colon carcinoma (CC) and acute diverticulitis (AD) on CT images and analyze the impact of the AI-support system in a reader study. DESIGN, SETTING, AND PARTICIPANTS In this diagnostic study, patients who underwent surgery between July 1, 2005, and October 1, 2020, for CC or AD were included. Three-dimensional (3-D) bounding boxes including the diseased bowel segment and surrounding mesentery were manually delineated and used to develop a 3-D convolutional neural network (CNN). A reader study with 10 observers of different experience levels was conducted. Readers were asked to classify the testing cohort under reading room conditions, first without and then with algorithmic support. MAIN OUTCOMES AND MEASURES To evaluate the diagnostic performance, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for all readers and reader groups with and without AI support. Metrics were compared using the McNemar test and relative and absolute predictive value comparisons. RESULTS A total of 585 patients (AD: n = 267, CC: n = 318; mean [SD] age, 63.2 [13.4] years; 341 men [58.3%]) were included. The 3-D CNN reached a sensitivity of 83.3% (95% CI, 70.0%-96.6%) and specificity of 86.6% (95% CI, 74.5%-98.8%) for the test set, compared with the mean reader sensitivity of 77.6% (95% CI, 72.9%-82.3%) and specificity of 81.6% (95% CI, 77.2%-86.1%). The combined group of readers improved significantly with AI support from a sensitivity of 77.6% to 85.6% (95% CI, 81.3%-89.3%; P < .001) and a specificity of 81.6% to 91.3% (95% CI, 88.1%-94.5%; P < .001). Artificial intelligence support significantly reduced the number of false-negative and false-positive findings (NPV from 78.5% to 86.4% and PPV from 80.9% to 90.8%; P < .001). CONCLUSIONS AND RELEVANCE The findings of this study suggest that a deep learning model able to distinguish CC and AD in CT images as a support system may significantly improve the diagnostic performance of radiologists, which may improve patient care.
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Affiliation(s)
- Sebastian Ziegelmayer
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Stefan Reischl
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Hannah Havrda
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Joshua Gawlitza
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Markus Graf
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Nicolas Lenhart
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Nadja Nehls
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Tristan Lemke
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, Technical University of Munich, School of Medicine, Munich, Germany
| | - Fabian Lohöfer
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Egon Burian
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | | | - Marcus Makowski
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Rickmer Braren
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
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3
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Cao AMY, Lam VW, Rickard MJFX. Endoscopic findings after
CT
proven acute diverticulitis: a systematic review and meta‐analysis. ANZ J Surg 2022; 93:1150-1158. [DOI: 10.1111/ans.18190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/12/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Amy Millicent Yesheng Cao
- Department of Surgery Macquarie University Hospital Sydney New South Wales Australia
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences Macquarie University Sydney New South Wales Australia
| | - Vincent Wai Lam
- Department of Surgery Macquarie University Hospital Sydney New South Wales Australia
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences Macquarie University Sydney New South Wales Australia
- Department of Hepatobiliary Surgery Westmead Hospital Sydney New South Wales Australia
| | - Matthew John Francis Xavier Rickard
- Department of Surgery Macquarie University Hospital Sydney New South Wales Australia
- Discipline of Surgery, School of Medicine, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
- Division of Colorectal Surgery, Department of Surgery Concord Repatriation General Hospital Sydney New South Wales Australia
- Department of Surgery Macquarie University Hospital Sydney New South Wales Australia
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Diverticulitis does not increase the long-term risk of developing colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:1945-1952. [PMID: 36042030 DOI: 10.1007/s00384-022-04246-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this review was to examine if diverticulitis increases the long-term risk (> 6 months) of developing colon cancer. METHODS A systematic search was conducted in PubMed, Embase, and Cochrane CENTRAL. Google Scholar was also searched. We included studies with human adults of 18 years of age and above. Studies that included only patients with diverticulitis as well as studies comparing groups with and without diverticulitis were included. The primary outcome was the incidence of colon cancer 6 months or more after an episode of diverticulitis. RESULTS Twelve records were included with 38,621 patients with diverticulitis. The crude rate of colon cancer among the prospectively followed populations with diverticulitis was by meta-analysis found to be 0.6% (95% CI 0.5-0.6%). The limitations of this review include heterogeneous reporting of outcomes across studies, specifically regarding population and outcome as well as variations in the design and reporting of the studies. CONCLUSION We found that the long-term risk of colon cancer after diverticulitis is not increased. The results of our review support current practice on follow-up after an episode of diverticulitis with short-term follow-up being the primary focus.
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Epidemiology of Diverticulitis and Prevalence of First-Ever Colorectal Cancer Postdiverticulitis in Adults in the United States: A Population-Based National Study. Dis Colon Rectum 2021; 64:181-189. [PMID: 33044246 DOI: 10.1097/dcr.0000000000001837] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The incidence of acute diverticulitis is increasing, and previous studies showed a wide range of prevalence of colorectal cancer after diverticulitis. There is a lack of high-quality evidence to support performing colonoscopy after diverticulitis. OBJECTIVE We aimed to describe the incidence of first-ever diverticulitis and prevalence of first-ever colorectal cancer postdiverticulitis in the United States. DESIGN This is a retrospective cohort study. SETTINGS We queried a national database that contains data from 26 major integrated healthcare systems in the United States. PATIENTS We identified an aggregated patient cohort aged ≥18 years with a diagnosis of first-ever diverticulitis from February 2015 to February 2020, followed by first-ever colorectal cancer diagnosis, at least 1 day after and within 1 year of diverticulitis. MAIN OUTCOME MEASURES The incidence of first-ever diverticulitis was calculated. The prevalence and OR of first-ever colorectal cancer after diverticulitis were analyzed. RESULTS Among 31,778,290 individuals, we found the incidence of first-ever acute diverticulitis to be 2.9%. The prevalence of colorectal cancer within 1 year of first-ever acute diverticulitis was 0.57%, whereas the prevalence of colorectal cancer without a history of diverticulitis was 0.31% (OR = 1.8 (95% CI, 1.76-1.86)). The majority (92.3%) of the postdiverticulitis colorectal cancer were diagnosed within the first 6 months. The risk of colorectal cancer postdiverticulitis was higher in women (OR = 1.9), African Americans (OR = 2.0), and adults aged 18 to 65 years (OR = 2.3). LIMITATIONS We are unable to validate the diagnostic code because patient information in our database is deidentified. CONCLUSIONS Individuals are twice as likely to be diagnosed with colorectal cancer within 1 year of their first episode of acute diverticulitis compared with individuals without diverticulitis. We advocate for colonoscopy after the first occurrence of acute diverticulitis to screen for colorectal cancer, particularly for patients without a recent colonoscopy. See Video Abstract at http://links.lww.com/DCR/B412.
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Cerdán Santacruz C, Muriel Álvarez P, Roig Ferreruela G, Merichal Resina M, Pinillos Somalo AI, Mestres Petit N, Sierra Grañón JE, Olsina Kissler JJ. Interval colonoscopy following acute diverticulitis should not be discouraged yet: results from a retrospective cohort. Surg Endosc 2021; 35:6819-6826. [PMID: 33398588 DOI: 10.1007/s00464-020-08187-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although included in some guidelines, the recommendation of interval colonoscopy after an acute diverticulitis (AD) episode has recently been questioned. In this study, we evaluated the incidence of colon cancer during the follow-up of an episode of AD. METHODS A retrospective review was carried out of patients with conservatively treated AD at our Institution (January 2011 to December 2018) with or without endoscopic study. Patients who had no colonoscopy performed were followed for two years. The demographic, clinical, radiological, follow-up and anatomopathological records were analysed. We determined CT scan validity for the differential diagnosis of CC and AD; sensibility, specificity, predictive values and likelihood ratios were calculated. Patients lost to follow-up and patients who had had colonoscopy in the previous three years were excluded. RESULTS This study included 285 patients with a mean age of 59 years. A total of 225 interval colonoscopies were performed and 60 patients without colonoscopy were followed up. There were 19 CC (6.7%) diagnosed, 14 with interval colonoscopy and 5 during follow-up; 8 (42.1%) happened in patients who had had an episode of uncomplicated AD. Although CT scan accuracy is high, 87.7%, positive and negative likelihood ratios were low, 4.67 and 0.64, respectively. CONCLUSIONS Interval colonoscopy should still be advisable after an episode of AD. The rationale for this statement is based on a non-negligible rate of hidden CC and an important uncertainty in the differential diagnosis.
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Affiliation(s)
- Carlos Cerdán Santacruz
- Colorectal Surgery Unit, General Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain.,Universidad de Lleida, Lleida, Spain
| | - Pablo Muriel Álvarez
- Liver, Biliary Tract and Pancreatic Surgery Unit, General Surgery Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain. .,Institut de Recerca Biomédica de Lleida, Experimental Surgery Department, Av. Prat de la Riba 44, 4º 5ª, Lleida, Spain.
| | | | | | | | - Nuria Mestres Petit
- Colorectal Surgery Unit, General Surgery Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain.,Universidad de Lleida, Lleida, Spain.,Institut de Recerca Biomédica de Lleida, Experimental Surgery Department, Av. Prat de la Riba 44, 4º 5ª, Lleida, Spain
| | - José Enrique Sierra Grañón
- Colorectal Surgery Unit, General Surgery Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Jorge Juan Olsina Kissler
- Liver, Biliary Tract and Pancreatic Surgery Unit, General Surgery Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain.,Universidad de Lleida, Lleida, Spain.,Institut de Recerca Biomédica de Lleida, Experimental Surgery Department, Av. Prat de la Riba 44, 4º 5ª, Lleida, Spain
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Fogelstrom A, Hallen F, Pekkari K. Computed tomography diagnosed first time diverticulitis and colorectal cancer. Int J Colorectal Dis 2020; 35:1895-1901. [PMID: 32524190 DOI: 10.1007/s00384-020-03607-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Computed tomography (CT) with intravenous contrast is the gold standard for diagnosing diverticulitis. Published results concerning follow-up colonoscopy after an episode of acute diverticulitis to rule out cancer are conflicting. This study aimed to evaluate the risk of underlying colonic malignancy in patients diagnosed with a first time diverticulitis with a state of the art CT investigation with intravenous contrast. METHODS Retrospective analysis of all patients with a first episode of diverticulitis diagnosed with CT at Danderyds Hospital, Stockholm, between January 1, 2015, and November 16, 2016. Data on modified Hinchey classification, age, sex, laboratory parameters, body mass index, and colonoscopy findings were recorded. RESULTS The study identified 518 patients with a CT-verified first time diverticulitis. Four hundred twenty-six (82%) of the 518 patients underwent follow-up colonoscopy and constitute our study cohort. CT showed that 402 patients had uncomplicated diverticulitis (modified Hinchey Ia), and 24 patients had complicated diverticulitis (modified Hinchey ≥Ib). Colonoscopy showed cancers in 2 (0.5%) of the 426 patients initially diagnosed as acute diverticulitis. In addition, 13 (3%) patients had advanced adenomas, and 121 (28%) patients had benign adenomas upon follow-up colonoscopy. Patients with CT-verified complicated diverticulitis (modified Hinchey ≥Ib) had a significantly higher risk for colon cancer compared with patients with an uncomplicated first time diverticulitis. CONCLUSION Our study supports routine follow-up colonoscopy after a first episode of CT-diagnosed complicated diverticulitis. In contrast, we do not find an increased risk for neoplasia in patients with uncomplicated diverticulitis.
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Affiliation(s)
- Anna Fogelstrom
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institute, S-182 88, Stockholm, Sweden
| | - Filip Hallen
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institute, S-182 88, Stockholm, Sweden
| | - Klas Pekkari
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institute, S-182 88, Stockholm, Sweden.
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Meyer J, Buchs NC, Schiltz B, Liot E, Ris F. Comment on: Should a colonoscopy be offered routinely to patients with CT proven acute diverticulitis? A retrospective cohort study and meta-analysis of best available evidence. World J Gastrointest Endosc 2020; 12:320-322. [PMID: 32994864 PMCID: PMC7503613 DOI: 10.4253/wjge.v12.i9.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/04/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
Latest evidence indicates that patients with acute diverticulitis have higher prevalence of colorectal cancer than reference patients. Therefore, colonoscopy should be offered after an episode of acute diverticulitis.
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Affiliation(s)
- Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1211, Switzerland
| | | | - Boris Schiltz
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1211, Switzerland
| | - Emilie Liot
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1211, Switzerland
| | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1211, Switzerland
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Krajicek EJ, Imperiale TF. Colonoscopy after acute diverticulitis: from clinical epidemiology to clinical management. Are we there yet? Gastrointest Endosc 2020; 91:641-642. [PMID: 32087901 DOI: 10.1016/j.gie.2019.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Eddie J Krajicek
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas F Imperiale
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Center for Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana; Regenstrief Institute, Inc, Indianapolis, Indiana
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Tehranian S, Klinge M, Saul M, Morris M, Diergaarde B, Schoen RE. Prevalence of colorectal cancer and advanced adenoma in patients with acute diverticulitis: implications for follow-up colonoscopy. Gastrointest Endosc 2020; 91:634-640. [PMID: 31521778 PMCID: PMC7039754 DOI: 10.1016/j.gie.2019.08.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/31/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Guidelines recommend colonoscopy after an episode of diverticulitis to exclude neoplasia but the effectiveness of testing is uncertain. Patients with complicated diverticulitis may be at higher risk for neoplasia, but most patients have uncomplicated disease. We examined the incidence of colorectal cancer (CRC) and advanced adenoma (AA) in patients with diverticulitis compared with patients undergoing screening colonoscopy. METHODS CT scans from January 1, 2008, to May 1, 2013, at the University of Pittsburgh Medical Center (UPMC) were reviewed to identify those with confirmed acute diverticulitis. Subsequent surgical, colonoscopy, and pathology reports were abstracted to identify those with a diagnosis of AA and CRC. The incidence of neoplasia was compared with that reported for screening colonoscopy from a meta-analysis (n = 68,324), and from colonoscopy examinations at UPMC between 2013 and 2015 (n = 28,573). RESULTS A total of 5167 abdominal/pelvic CT scan reports identified 978 patients with acute diverticulitis, among which 474 (48.5%) patients had undergone at least 1 colonoscopy or gastrointestinal surgery to April 2015. The CRC rate in patients with diverticulitis (13/474, 2.7%) was significantly higher (P < .0001) compared with both the meta-analysis (0.8%) and UPMC (0.3%). The AA rate (19/474, 4.0%) was similar to the rate in the meta-analysis (5.0%, P = .39) but significantly lower than at UPMC (7.7%, P = .003). The incidence of AA or CRC in complicated diverticulitis (10/141, 7.1%) did not differ significantly (P = .85) from the incidence of AA or CRC in uncomplicated diverticulitis (22/332, 6.6%). CONCLUSIONS CRC after diverticulitis was significantly higher than that observed at screening colonoscopy and was not limited to complicated disease. Colonoscopy is advisable after the diagnosis of diverticulitis.
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Affiliation(s)
- Shahrzad Tehranian
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA
| | - Matthew Klinge
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA
| | - Melissa Saul
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Michele Morris
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA
| | - Brenda Diergaarde
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, and UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Robert E. Schoen
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA,Corresponding author: Robert E. Schoen, MD, MPH, Division of Gastroenterology, Hepatology and Nutrition, Mezzanine Level, C Wing, PUH, 200 Lothrop St, Pittsburgh, PA 15213-2582,
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Díaz JJT, Asenjo BDA, Soriano MR, Fernández CJ, Aurusa JODS, Rentería JPBDH. Efficacy of colonoscopy after an episode of acute diverticulitis and risk of colorectal cancer. Ann Gastroenterol 2020; 33:68-72. [PMID: 31892800 PMCID: PMC6928487 DOI: 10.20524/aog.2019.0437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/14/2019] [Indexed: 01/17/2023] Open
Abstract
Background Diverticular disease of the colon has a high global prevalence. The guidelines suggest performing a colonoscopy 4-6 weeks after the acute episode to exclude colorectal cancer (CRC). However, these recommendations are based on old studies, when computed tomography was not used to diagnose acute diverticulitis (AD). There are currently some studies showing that CRC incidence is low in uncomplicated AD (UAD). Therefore, we decided to perform this study to determine the CRC incidence after an AD episode and the diagnostic efficacy of colonoscopy in these patients. Method This was a retrospective cohort study that included patients with AD between July 2016 and December 2017. Results One hundred seventy-four patients had AD. Of these, 46 patients were excluded and we analyzed 128 patients, 72 (56.3%) women and 56 (43.7%) men. Ninety (70.3%) had UAD and 38 (29.7%) complicated AD (CAD). The colonoscopy showed lesions in 18 (14.06%), 5 (3.9%) being CRC. The patients with CRC had shown CAD and were >70 years old (P=0.0001 and P=0.002 respectively). Conclusions Routine colonoscopy in patients with UAD appears not have many benefits as a diagnostic tool. However, it has a higher efficacy if the patients have CAD and are >70 years old.
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Affiliation(s)
- Jeancarlos Jhosmer Trujillo Díaz
- Department of General and Digestive Surgery, (Jeancarlos Jhosmer Trujillo Díaz, Beatriz De Andrés Asenjo, María Ruiz Soriano, Carlos Jezieniecki Fernández, Javier Ortiz de Solórzano Aurusa, Juan Pablo Beltrán de Heredia y Rentería).,Colorectal Surgery Unit (Jeancarlos Jhosmer Trujillo Díaz, Beatriz De Andrés Asenjo, Javier Ortiz de Solórzano Aurusa), Valladolid University Clinic Hospital, Spain
| | - Beatriz De Andrés Asenjo
- Department of General and Digestive Surgery, (Jeancarlos Jhosmer Trujillo Díaz, Beatriz De Andrés Asenjo, María Ruiz Soriano, Carlos Jezieniecki Fernández, Javier Ortiz de Solórzano Aurusa, Juan Pablo Beltrán de Heredia y Rentería).,Colorectal Surgery Unit (Jeancarlos Jhosmer Trujillo Díaz, Beatriz De Andrés Asenjo, Javier Ortiz de Solórzano Aurusa), Valladolid University Clinic Hospital, Spain
| | - María Ruiz Soriano
- Department of General and Digestive Surgery, (Jeancarlos Jhosmer Trujillo Díaz, Beatriz De Andrés Asenjo, María Ruiz Soriano, Carlos Jezieniecki Fernández, Javier Ortiz de Solórzano Aurusa, Juan Pablo Beltrán de Heredia y Rentería)
| | - Carlos Jezieniecki Fernández
- Department of General and Digestive Surgery, (Jeancarlos Jhosmer Trujillo Díaz, Beatriz De Andrés Asenjo, María Ruiz Soriano, Carlos Jezieniecki Fernández, Javier Ortiz de Solórzano Aurusa, Juan Pablo Beltrán de Heredia y Rentería)
| | - Javier Ortiz de Solórzano Aurusa
- Department of General and Digestive Surgery, (Jeancarlos Jhosmer Trujillo Díaz, Beatriz De Andrés Asenjo, María Ruiz Soriano, Carlos Jezieniecki Fernández, Javier Ortiz de Solórzano Aurusa, Juan Pablo Beltrán de Heredia y Rentería).,Colorectal Surgery Unit (Jeancarlos Jhosmer Trujillo Díaz, Beatriz De Andrés Asenjo, Javier Ortiz de Solórzano Aurusa), Valladolid University Clinic Hospital, Spain
| | - Juan Pablo Beltrán de Heredia Rentería
- Department of General and Digestive Surgery, (Jeancarlos Jhosmer Trujillo Díaz, Beatriz De Andrés Asenjo, María Ruiz Soriano, Carlos Jezieniecki Fernández, Javier Ortiz de Solórzano Aurusa, Juan Pablo Beltrán de Heredia y Rentería)
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Risk of Colorectal Cancer in Patients With Acute Diverticulitis: A Systematic Review and Meta-analysis of Observational Studies. Clin Gastroenterol Hepatol 2019; 17:1448-1456.e17. [PMID: 30056181 DOI: 10.1016/j.cgh.2018.07.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We performed a systematic review and meta-analysis to assess the prevalence of colorectal cancer in patients with acute diverticulitis. METHODS We searched MEDLINE from inception through November 2nd, 2017 for studies reporting the prevalence of colorectal cancer in patients with diverticulitis, identified based on the protocol CRD42017083272. This systematic review was conducted in accordance to the MOOSE guidelines. Pooled prevalence values were obtained by random effects models and robustness was tested by leave-one out sensitivity analyses. Heterogeneity was assessed using the Q-test and quantified based on I2 value. The critical appraisal of included studies was performed using the Newcastle-Ottawa scale. RESULTS Our final analysis included 31 studies, comprising 50,445 patients. The pooled prevalence of colorectal cancer was 1.9% (95% CI, 1.5%-2.3%). Patients with complicated diverticulitis had a significantly higher risk for colorectal cancer (prevalence, 7.9%; 95% CI, 3.9%-15.3%) than patients with uncomplicated diverticulitis (prevalence, 1.3%; 95% CI, 0.1%-2%), corresponding to a pooled prevalence ratio of 6.7 (95% CI, 2.5-18.3). Subgroup analyses did not find significant difference in prevalence when separately pooling studies according to ranking on the Newcastle-Ottawa scale, geographical location or length of follow-up. Meta-regression did not find any association between age and colorectal cancer. Among patients who underwent endoscopy, the pooled prevalence of polyps was 22.7% (95% CI, 19.6%-26.0%), of advanced adenomas was 4.4% (95% CI, 3.4%-5.8%), of adenomas was 14.2% (95% CI, 11.7%-17.1%), and of hyperplastic polyps was 9.2% (95% CI, 7.6%-11.2%). CONCLUSION In a meta-analysis of observational studies of patients with acute diverticulitis, we found the pooled prevalence of colorectal cancer to be 1.9%. The risk of colorectal cancer was significantly higher in patients with complicated diverticulitis than in patients with uncomplicated diverticulitis.
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Meyer J, Buchs NC, Ris F. Risk of colorectal cancer in patients with diverticular disease. World J Clin Oncol 2018; 9:119-122. [PMID: 30425936 PMCID: PMC6230995 DOI: 10.5306/wjco.v9.i6.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/04/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer constitutes an important burden on the healthcare system. Screening at-risk populations to reduce colorectal cancer-related morbidity and mortality has become part of good clinical practice. However, recommendations regarding subgroups of patients with diverticular disease are subject to controversy.
Herein, we review the most recent literature regarding the prevalence of colorectal cancer in patients with diverticular disease, diverticulitis and uncomplicated diverticulitis.
The recent literature does not identify diverticular disease as a long-term risk factor for colorectal cancer. However, the risk of colorectal cancer is increased in the short-term period after hospitalization related to diverticular disease. According to a recent systematic review and meta-analysis, the prevalence of colorectal cancer is 1.6% in patients with acute diverticulitis who underwent colonoscopy. The risk of having colorectal cancer after an episode of acute diverticulitis is 44-fold higher than that of an age- and gender-adjusted reference population. Despite lower among patients with uncomplicated episode, the risk of colorectal cancer remains 40-fold higher in that subpopulation than that in the reference population.
To conclude, the recent literature describes an increased risk of colorectal cancer among patients with acute diverticulitis compared to the reference population. Colonoscopy is therefore recommended in patients with diverticulitis to exclude colorectal cancer.
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Affiliation(s)
- Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1211, Switzerland
| | | | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1211, Switzerland
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