R1 임형석 The risk of colorectal cancer after an attack of uncomplicated diverticulitis BJARKI T. ALEXANDERSSON1, JOHANN P. HREINSSON1,4, TRYGGVI STEFANSSON2, JON GUNNLAUGUR JONASSON3,4,5 & EINAR S. BJORNSSON1,4 Scandinavian Journal of Gastroenterology, 2014

B ACKGROUND  According to previous studies  patients with acute diverticulitis should undergo colonoscopy 4–6 weeks later to exclude CRC  analyzed all cases of diverticulitis but not only those with uncomplicated diverticulitis  diagnosed clinically without the aid of CT scan of the abdomen  these studies are more than 20 years old

B ACKGROUND  CT of the abdomen, by contrast, reliably confirms the diagnosis diverticulitis  >therefore, used to diagnose this condition  Little data are available on the risk of finding CRC in patients who experience an attack of uncomplicated diverticulitis  Aim of this study  to investigate the findings of a subsequent colonoscopy after an attack of uncomplicated diverticulitis

M ATERIALS and M ETHODS  National Hospital of Iceland(2006~2011)  Retrospective and population based  with additional information from the population-based Icelandic Cancer Registry  K 57.3 “Diverticular Disease of large intestine without perforation or abscess  (1) abdominal pain  (2) abdominal tenderness  (3) CT of abdomen: diverticulosis, thickening of the colonic wall(>=5 mm), inflammation of the surrounding fat

MATERIALS and METHODS  Complicated diverticulitis  (1) pericolonic or abdominal abscess  (2) localized or free extra luminal gas  (3) obstruction  (4) fistula formation  (5) presence of an associated mass lesion  Starting at date of uncomplicated diverticulitis diagnosis  The endpoint was date of colorectal cancer diagnosis, date of death or December 31, 2012, whichever came first

MATERIALS and METHODS  Standardized incidence ratios (SIRs)  Ratio: observed cases / expected number  expected number = from the national cancer incidence rates, by sex, age, and at the same calendar years

R ESULTS

 N = 199  Uncomplicated diverticulitis criteria +  undergone colonoscopy R ESULTS

 Only 2/282(0.7%) were found to have CRC(IIB, T4N0M0)  70-years-old woman, who went straight to surgery  71-years-old woman, who underwent colonoscopy  these two patients had persistent abdominal symptoms until they were diagnosed with CRC  rest of the patients all recovered clinically and were discharged from the hospital  SIR: 2/0.83 = 2.40  Thus, the observed number of CRC cases was not significantly higher than the expected CRC cases R ESULTS

C ONCLUSION  if the patient recovers clinically  not necessary to perform a colonoscopy  prolonged course of diverticulitis  increases the odds of having CRC  important in determining the need for colonoscopies in asymptomatic subjects  these might decrease the work load in endoscopy units.