Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.
This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.
Advice
For a person with CT-diagnosed diverticulitis, a diagnostic colonoscopy is not advised for diagnosing bowel cancer if the person has had a normal colonoscopy within the past two years and there are no other flags for other pathology (positive faecal test, anaemia, rectal bleeding.
When is the procedure indicated?
A diagnostic colonoscopy should be undertaken for a person with CT-diagnosed diverticulitis if new symptoms arise within two years of a normal colonoscopy.
Colorectal cancer, particularly at an early stage, cannot be excluded through a CT scan. Diverticulitis and colorectal cancer or adenomatous polyps can co-exist as both are common. A diagnostic colonoscopy is warranted if the CT scan shows possible signs of malignancy.
If a person remains asymptomatic after CT-diagnosed diverticulitis, a follow-up colonoscopy should take place at an interval of five years after the preceding colonoscopy.
Best care recommendations
For a person with CT-diagnosed diverticulitis who has had no new symptoms since their last colonoscopy, alternative options should be considered for follow-up assessment.
For a person aged between 50 and 74, a faecal occult blood test (FOBT) should be undertaken through the government-funded National Bowel Cancer Screening Program every two years. If any abnormalities are detected through an FOBT test, further diagnostic assessment is indicated.
Evidence
Cancer Council Australia Colorectal Cancer Guidelines Working Party. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer [Internet]. Sydney (NSW): Cancer Council Australia; 2017 [cited 2020 Jun 13].
Department of Health and Human Services. Specialist clinics resources: The Victorian Endoscopy Categorisation Decision Support Tool [Internet]. Melbourne (VIC): Department of Health and Human Services; 2017 [cited 2020 Nov 20].
Ou G, Rosenfeld G, Brown J, Chan N, Hong T, Lim H, et al. Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary? Canadian Journal of Surgery. 2015 Aug;58(4):226.
Sai VF, Velayos F, Neuhaus J, Westphalen AC. Colonoscopy after CT diagnosis of diverticulitis to exclude colon cancer: a systematic literature review. Radiology. 2012 May;263(2):383-90.
Zaman S, Warren Chapman IM, Gill K, Ward ST. Patients with computed tomography-proven acute diverticulitis require follow-up to exclude colorectal cancer. Intestinal Research. 2017 Apr;15(2):195.