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Is It Time to Change Practice of Routine Colonoscopy After Acute Diverticulitis?

We read with interest the article by Sharma et al, a well-executed metaanalysis concerning the need for colonoscopy after acute diverticulitis. By studying a total of 1970 patients, they found that risk for colon cancer mimicking diverticulitis is approximately 10% in the case of complicated diverticulitis and 0.7% in uncomplicated diverticulitis. They conclude that routine colonoscopy may not be necessary after radiologically confirmed uncomplicated diverticulitis. Although we agree with their conclusions, we do have some comments. One study included in the metaanalysis used ultrasonography (US) to diagnose acute diverticulitis in 112 patients. This might be justified as US is recommended as a first-line diagnostic tool for all in some countries such as The Netherlands and for fertile-age women in others such as Denmark. However, few studies compare computed tomography (CT) to US in the diagnosis of acute diverticulitis. Farag et al and Pradel et al found excellent concordance of CT and US but made no distinction between uncomplicated and complicated diverticulitis, which is crucial considering the risk for colon cancer mimicking diverticulitis. On the contrary, a recent study by Nielsen et al found that US misclassifies CT-verified complicated diverticulitis in 79% of cases! As CT-diagnosed complicated diverticulitis has approximately a 10% risk of being colon cancer instead, it is of paramount interest