EP701 - Are we following up? Colonoscopy after Diverticulitis- A Retrospective Review

Purpose/Background: Diverticulitis, characterized by inflammation of diverticula in the colon, is a common condition, particularly among older adults. Clinical guidelines recommend a follow-up colonoscopy to rule out underlying pathologies, such as colorectal cancer. However, adherence to these guidelines and access to necessary follow-up care can vary significantly based on patient demographics and socioeconomic factors

Methods/Interventions: A retrospective chart review was conducted of 762 adult patients presenting to the emergency department of a single academic center with CT-confirmed diverticulitis between January 2023 and January 2024. Outcomes included rates and timing of colonoscopy after diverticulitis, referral patterns, colonoscopy findings, and disparities by demographic and socioeconomic factors.

Results/Outcomes: Of 762 patients, 609 (79.9%) had uncomplicated and 153 (20.1%) had complicated diverticulitis. Colonoscopy was recommended in 399 (52.4%) patients, of whom 218 underwent the procedure. %); of these, 117 (29.3%) underwent timely colonoscopy, 101 (25.3%) had delayed procedures, and 166 (41.6%) did not complete colonoscopy. Findings on follow-up colonoscopy (n=218) revealed adenomas in 37.2%, advanced adenomas in 4.1%, and colorectal cancer in 0.9% (n=2). Both of the patients with diagnosed colorectal cancer on colonoscopy had initial presentation of complicated diverticulitis. Reasons for non-completion for complicated diverticulitis included colonoscopy within 5 years (46.8%), need for surgery (21.3%), lack of referral (8.5%), multiple episodes (6.4%), and lost to follow up (10.6%). There was no statistically significant difference in demographics between patients that did and did not complete a follow up colonoscopy. Patients without a primary care provider were significantly less likely to undergo follow up colonoscopy (p=.001). While not statistically significant, patients with history of prior colonoscopy, personal history of cancer, and private insurance were more likely to follow through.

Conclusion/Discussion: This study highlights that post-diverticulitis colonoscopy completion rates are lower than guideline targets; however, many missed scopes were clinically justified. The low CRC detection rate, particularly among uncomplicated cases, raises the question of over-referral and potential overuse of colonoscopy. Disparities related to primary care access, insurance, and referral coordination were identified. Implementation of a system-level, structured, evidence-based pathway could prioritize high-risk patients, improve care coordination and reduce inequities.