Monitoring
The American College of Physicians recommends referring patients for colonoscopy following an episode of complicated left-sided colonic diverticulitis if these patients have not had a recent colonoscopy. This is to exclude colorectal cancer or advanced colonic neoplasia if there is diagnostic uncertainty.[101][113] The American Gastroenterological Association (AGA) recommends colonoscopy after an episode of complicated diverticulitis. The AGA states that colonoscopy can be deferred if a recent (within 1 year) high-quality colonoscopy has been performed.[12] Although there is no established association between diverticular disease and increased risk of colorectal neoplasia, screening colonoscopy for colorectal cancer should be considered in patients older than the age of 50 years at normal risk of colorectal cancer, and earlier in those at high risk.[111][112] In a recent meta-analysis of observational studies of patients with acute diverticulitis, the pooled prevalence of colorectal cancer was 1.9%. The risk of colorectal cancer was significantly higher in patients with complicated diverticulitis than in patients with uncomplicated diverticulitis.[114]
Perform a colonoscopy 6 to 8 weeks after an acute episode of complicated diverticulitis or after a first episode of uncomplicated diverticulitis. If a high-quality colonoscopy was performed in the previous year and no alarm symptoms are present, the examination does not need to be repeated. For patients with recurrent uncomplicated diverticulitis and no alarm symptoms, follow routine colorectal cancer screening and surveillance intervals.[54]
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