Endoscopy International Open (Feb 2021)

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

  • Dai Nakamatsu,
  • Tsutomu Nishida,
  • Shinji Kuriki,
  • Li-sa Chang,
  • Kazuki Aochi,
  • Emi Meren,
  • Tatsuya Sakamoto,
  • Ryo Tomita,
  • Yu Higaki,
  • Naoto Osugi,
  • Aya Sugimoto,
  • Kei Takahashi,
  • Kaori Mukai,
  • Kengo Matsumoto,
  • Shiro Hayashi,
  • Sachiko Nakajima,
  • Masashi Yamamoto,
  • Koji Fukui,
  • Masami Inada

DOI
https://doi.org/10.1055/a-1333-1108
Journal volume & issue
Vol. 09, no. 03
pp. E331 – E337

Abstract

Read online

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.