A. Studniarek1, J. Nordenstam1, K. Kochar3, V. Chaudhry2, A. Mellgren1, G. Gantt1 2Cook County Health and Hospitals System,Division Of Colon And Rectal Surgery,Chicago, IL, USA 3Advocate Lutheran General Hospital,Division Of Colon And Rectal Surgery,Park Ridge, IL, USA 1University Of Illinois At Chicago,Division Of Colon And Rectal Surgery,Chicago, IL, USA
Introduction:
Current clinical guidelines recommend performing a colonoscopy after resolution of diverticulitis to confirm the diagnosis and to exclude malignancy or other pathology. Incomplete colonoscopies have limited yield of significant pathologies. The aim of this study is to evaluate the relative risk of surgical intervention after incomplete diagnostic colonoscopies in comparison to complete colonoscopic evaluations after diverticulitis.
Methods:
This is a retrospective descriptive analysis of patients who underwent diagnostic colonoscopy after an episode of acute diverticulitis between November 2005 and August 2017 at three major teaching hospitals in Chicago, Illinois. Demographics, computed tomography scans, endoscopy findings, and surgical pathologies were evaluated. Complete colonoscopy was defined as a full cecal intubation, with visualization of the appendiceal orifice and the ileocecal valve. Severity of diverticulitis was classified based on Hinchey classification during the patient’s initial presentation. The primary outcome of this study was surgical intervention following colonoscopic evaluation.
Results:
584 patients (298 male; 51%) underwent a colonoscopy for a history of diverticulitis after resolution of acute symptoms. Median patient age was 53 (range, 22-88) years. Colonoscopy was complete in 488 patients (83%). 82 patients (17%, 82/488) underwent surgery and 406 (83%, 406/488) did not require surgical intervention. Out of those who underwent surgery with complete colonoscopies, 44 patients (54%, 44/82) presented with Hinchey 1 or 2 diverticulitis. Colonoscopy was incomplete in 96 patients (16%, 96/584). 46 of these patients (48%, 46/96) underwent surgery. 31 patients (67%, 31/46) were classified as Hinchey 1 or 2 on the initial presentation. Patients with incomplete colonoscopies had higher relative risk of undergoing surgical intervention (RR ,2.85; 95% CI, 2.14-3.80) than patients with complete colonoscopies (RR, 0.35; 95% CI, 0.26-0.47).
Conclusion:
Diagnostic colonoscopy following an episode of diverticulitis has a high rate of incomplete examinations. The patients who undergo an incomplete colonoscopy after an episode of diverticulitis have a higher probability of undergoing surgical intervention in comparison to the patients who had a complete colonoscopy. A more accurate diagnostic modality and further prospective studies may help avoid unnecessary surgical procedures.
