SA203 - Long-term Follow-up After an Initial Episode of Diverticulitis: A 15 Year Update

Saturday, June 1, 2024

2:37 PM – 2:43 PM ET, USA

Location: Room 314-317

Author(s)

Sarah N. Anwar, BS

Medical Student
Lahey Hospital & Medical Center, Tufts University School of Medicine
Cambridge, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Abstract Podium Presenter(s)

Gabrielle E. Dombek, MD

CRS Fellow
Lahey Hospital and Medical Center
Lahey
Melrose, Massachusetts, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

CH

Caroline Hayes, n/a

Medical Student
Beth Israel Lahey Hospital, Tufts University School of Medicine
Boston, Massachusetts, United States

Disclosure information not submitted.
Maggie J. McMahon, BA, MS (she/her/hers)

Medical Student
Tufts University School of Medicine
Lahey Hospital and Medical Center
Boston, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
CM

Cody Munroe, BS, MS

Clinical Research Coordinator
Lahey Hospital
Windham, New Hampshire, United States

Disclosure information not submitted.
Jonathan Abelson, MD MS (he/him/his)

Staff Surgeon
Lahey Hospital and Medical Center
Tufts Medical Center
ARLINGTON, Massachusetts, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
Jason F. Hall, MD MPH FACS FASCRS

Chairman, Department of Surgery
Tufts Medical Center
Tufts Medical Center/Tufts University School of Medicine
Lincoln, Massachusetts, United States

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This individual has no financial relationships with ineligible companies.
David A. Kleiman, MD, MSc, FACS, FASCRS

Staff Surgeon
Lahey Hospital & Medical Center
Melrose, MA, United States

Disclosure information not submitted.
AK

Angela H. Kuhnen, MD, MPH, FACS, FASCRS (she/her/hers)

Fellowship Program Director, Staff surgeon
Lahey Clinic
Tufts University School of Medicine
Burlington, Massachusetts, United States

Disclosure information not submitted.
Peter W. Marcello, MD, FACS, FASCRS (he/him/his)

Chair, Division of Colon & Rectal Surgery
Lahey Hospital & Medical Center
Burlington, Massachusetts, United States

Disclosure information not submitted.

Senior Author(s)

JS

Julia T. Saraidaridis, MD, MMSc

Staff Colon and Rectal Surgeon
Lahey Hospital
Newton, Massachusetts, United States

Disclosure information not submitted.

Purpose/Background: For patients with uncomplicated diverticulitis, the trigger to proceed to elective sigmoid colectomy is still unclear. Current clinical practice guidelines suggest this is an individualized decision between surgeon and patient. The purpose of this study was to assess long-term (greater than 15 year) risk of diverticulitis recurrence and determine clinical and CT predictors of recurrent disease.

Methods/Interventions: Consecutive patients who presented with CT-proven diverticulitis between 2002 and 2008 were analyzed. Patients were identified with ICD-9/CPT codes. Patients were excluded if they had a previous episode of diverticulitis. Clinical variables were coded based on retrospective chart review and imaging variables were coded by blinded radiology review. From 2022-2023 all patients were contacted via telephone to perform a short questionnaire regarding diverticulitis recurrence. Univariate analysis was performed with a log-rank test of Kaplan-Meier estimates. Multivariate analysis was performed using Cox proportional hazards.

Results/Outcomes: 954 patients were identified. 201 had previous diverticulitis and were excluded leaving 753 patients as the study population. The mean age was 61.5 years (SD 15.3) and median follow-up was 13.2 years (IQR 3.8-18.3). 486 (64.5%) were alive at time of follow-up. 353 (46.9%) experienced recurrent disease and 63 (8.4%) had 4 or more episodes. Median time to recurrence was 2.9 years (IQR 0.8-8.5 years). 29 (3.9%) required IR drainage. 37 (4.9%) required emergency surgery and 43 (5.7%) underwent eventual elective surgery following initial presentation. Those who had surgery following their first episode (80 patients) were excluded from analyses regarding disease recurrence (n=673). On univariate analysis, sigmoid disease (HR 1.5, p < .01), presence of abscess (HR 1.86, p < .01), smoldering disease (HR 3.7, p < .01), requiring an IR drain (HR 3.1, p < .01), >5 cm of involved segment (HR 1.45, p < .01), maximum fat stranding > 1.8 cm (HR 1.43, p < .01, irritable bowel syndrome (HR 1.43, p=.05), and family history of diverticulitis (HR 1.62, p < .01) were associated with higher incidence of recurrence. On multivariate analysis, smoldering disease (HR 3.17, p< 0.01), sigmoid disease (HR 1.35, p=0.03), female sex (HR 1.28, p=0.04), length of involved segment greater than 5 cm (HR 1.28, p=0.04), and maximum fat diameter greater than 1.8 cm (HR 1.29, p=0.03) were associated with disease recurrence. Kaplan Meier generated estimates of freedom from recurrence were 73.1% (69.6-76.3%) at 1 year, 47.9% (44.0-51.6%) at 5 years, and 34.6% (31.0-38.2%) at 10 years following initial presentation.

Conclusion/Discussion: After a single episode of diverticulitis, incidence of recurrence is more than 50% on long-term follow-up. Increased risk of recurrence was seen in patients with smoldering disease, sigmoid disease, female sex, length of involved segment greater than 5 cm, or maximum fat stranding diameter greater than 1.8 cm. These findings should be considered when counseling patients on decision to proceed with elective colectomy for recurrent diverticulitis.