SP 3.03 Follow-Up Endoscopy and Colorectal Cancer Incidence After Acute Diverticulitis in Emergency General Surgery
Andrea Giorga, Sanyu Nkaze Yanno, Adam Peckham-CooperAbstract
Aims
Acute diverticulitis represents a significant workload within Emergency General Surgery (EGS). Historically, routine post-episode endoscopic assessment has been performed to exclude colorectal cancer (CRC). With advances in CT imaging and evolving guidelines advocating selective follow-up, this study aimed to evaluate CRC incidence after acute diverticulitis, assess the ability of CT to identify patients at risk, and review EGS follow-up practice against contemporary recommendations.
Methods
A retrospective study was conducted of all CT scans containing the term “divertic” over a 12-month period. Records were screened to identify patients with CT-confirmed diverticulitis. Patients were stratified into "non-suspicious" or "suspicious" groups based on radiological reporting, irrespective of disease complexity. Data collected included diverticulitis severity, follow-up endoscopic assessment, and CRC diagnosis.
Results
Of 1,276 records identified, 365 patients had confirmed diverticulitis. Overall CRC incidence was 1.36% (5/365). CRC was detected in 6.5% (4/62) of patients with suspicious CT features compared with 0.3% (1/303) in the non-suspicious group. All confirmed CRC cases demonstrated radiological suspicion on the index CT. No CRC-related mortality was observed. Follow-up endoscopy was performed in 33.4% of patients overall, including 28.7% of non-suspicious cases. Notably, all CRCs occurred in patients with uncomplicated diverticulitis but suspicious imaging features.
Conclusions
In the EGS setting, CT imaging effectively stratifies malignancy risk following acute diverticulitis. Routine endoscopic follow-up after non-suspicious CT-proven diverticulitis has low diagnostic yield and contributes to pathway burden. A selective, CT-guided follow-up strategy appears safe and supports efficient emergency surgical care, consistent with current guidance.