#11 Endoscopic Grading of Diverticulitis

Study #11

Part of my colonoscopy database was a prospective recording of the presence and severity of diverticulosis in every patient. This study capitalizes on the data to look at the association between endoscopic severity of diverticulosis and the chances of needing surgery for diverticulitis later in life. The data suggest that endoscopic severity can be used as one of the factors determining surgical strategy.

Dean M, Valentino J, Ritter K, Church J. A novel endoscopic grading system for prediction of disease-related outcomes in patients with diverticulosis. Am J Surg. 2018; 216: 926-931.

Background: We describe a simple endoscopic grading system of diverticular disease for the assessment of disease severity and prediction of outcomes.

Methods: A retrospective analysis of prospectively maintained colonoscopy database was conducted. A single endoscopist prospectively graded disease severity according to the number and size of diverticula, the degree of muscular hypertrophy and rigidity of the sigmoid colon.

Results: 762 patients were included in the analysis. Mean patient age was 70 years (range 37-97). Endoscopic severity of diverticulosis was predictive of the need for surgery, with 2% in the mild-moderate, 12% in the severe and 33% in the acute group (p < 0001). Time to surgery showed correlation to severity grade, with mean periods of 107.5 months in the moderate group vs. 3 and 2.5 months in the severe and acute group (p < 0001). The mean follow up was 11 years.

Conclusion: Surgeons should consider using endoscopic grading as an adjunct to clinical management decisions.