title: Colonoscopy after the first episode of acute diverticulitis: challenging management paradigms.
abstract: BACKGROUND
  Colonoscopy is commonly recommended after the first episode of acute diverticulitis to exclude colorectal neoplasia. Recent data have challenged this paradigm due to insufficient diagnostic yield. The aim of this study was to assess whether colonoscopy after the first episode of acute diverticulitis is needed to exclude colorectal neoplasia.
  
  
  METHODS
  We performed a retrospective cohort analysis of medical records of patients admitted for the first episode of acute diverticulitis between January 2008 and December 2012. Ambulatory colonoscopy was routinely recommended at discharge. Clinical follow-up and telephone surveys were used for data collection.
  
  
  RESULTS
  Four hundred and twenty-five patients with a mean age of 62.6 years (range 21-98 years) were admitted during the 5-year period. Three hundred and ten (72.9 %) patients underwent colonoscopy at median time of 3.2 months after discharge. Five patients (1.6 %) of the 310 available for evaluation had malignant findings in colonoscopy. Of those, one patient had rectal carcinoma away from the inflamed site and one had colonic lymphoma. None of the 95 patients <50 years of age was found to have adenocarcinoma of the colon.
  
  
  CONCLUSIONS
  Cancer is rarely detected in colonoscopy following the first episode of acute diverticulitis. These results question this indication for colonoscopy, especially in patients under 50.
authors.affiliation: Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel. nir_horesh@hotmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Horesh
authors.affiliation: Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Saeed
authors.affiliation: Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel.
authors.forename: H
authors.initials: H
authors.lastname: Horesh
authors.affiliation: Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Berger
authors.affiliation: Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel.
authors.forename: C
authors.initials: C
authors.lastname: Speter
authors.affiliation: Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Pery
authors.affiliation: Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Rosin
authors.affiliation: Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Gutman
authors.affiliation: Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Zmora
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000209:etiology; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D019564:Unnecessary Procedures / Q000379:methods*; D055815:Young Adult
keywords: Acute diverticulitis; Colon cancer; Colonoscopy; Colorectal surgery