From the Guidelines
Colonoscopy is indicated for diverticulitis bleed, but it should be delayed by 6–8 weeks or until complete resolution of the acute symptoms, whichever is longer, to minimize the risk of complications and ensure proper visualization of the colon. This recommendation is based on the most recent and highest quality study, which suggests that colonoscopy after an episode of diverticulitis depends on the patient’s history, most recent colonoscopy, and course of the disease 1. The study found that the risk of colon cancer was higher in patients with complicated diverticulitis (7.9%) compared with patients with uncomplicated diverticulitis (1.3%) 1.
Some key points to consider when deciding on colonoscopy for diverticulitis bleed include:
- The patient's history and most recent colonoscopy results
- The presence of alarm symptoms such as change in stool caliber, iron deficiency anemia, blood in stool, weight loss, and abdominal pain
- The risk of colon cancer and advanced adenomas in patients with diverticulitis
- The potential complications of colonoscopy, such as perforation and bleeding
According to the American College of Physicians, colonoscopy should be considered after an initial episode of complicated left-sided colonic diverticulitis in patients who have not had recent colonoscopy 1. However, for patients with uncomplicated diverticulitis, colonoscopy may be deferred if a recent (within 1 year) high-quality colonoscopy was performed and there were no findings warranting short interval follow up 1.
It's also important to note that colonoscopy should not be performed until the acute phase of diverticulitis is resolved, and patients should complete their full course of antibiotics and ensure symptoms have completely resolved before undergoing colonoscopy 1.
In terms of specific timing, the study suggests that colonoscopy should be delayed by 6–8 weeks or until complete resolution of the acute symptoms, whichever is longer 1. This allows for proper healing of the colon and minimizes the risk of complications.
Overall, the decision to perform colonoscopy for diverticulitis bleed should be individualized based on the patient's specific circumstances and medical history, and should take into account the potential benefits and risks of the procedure 1.
From the Research
Indications for Colonoscopy in Diverticulitis Bleed
- Colonoscopy is indicated for diverticulitis bleed to rule out malignancy 2
- It can be used for both diagnosis and treatment of colonic diverticular bleeding 3
- Endoscopic hemostasis methods, such as clipping, endoscopic band ligation, injection therapy, and thermal contact, are available for treatment 3
Diagnostic Yield of Colonoscopy
- The diagnostic yield of colonoscopy after the first episode of acute diverticulitis is low, with a small percentage of patients found to have malignant findings 4
- Cancer is rarely detected in colonoscopy following the first episode of acute diverticulitis, questioning the indication for colonoscopy in this setting 4
Endoscopic Therapy for Acute Diverticular Bleeding
- Endoscopic therapy, including injection/thermal contact therapy, clipping, endoscopic band ligation, hemostatic powder, and over-the-scope clips, can provide secure initial hemostasis 5
- The clinical outcomes after endoscopic treatment, such as initial hemostasis and early recurring bleeding, are similar among different methods, but endoscopic band ligation may prevent the need for transcatheter arterial embolization or surgery 5