Colonic Diverticulosis Associated With an Increased Risk of Adenomas: 282

Introduction: Colonic diverticulosis is a frequently discovered condition in patients during colonoscopy. Many risk factors for the disease, such as male gender and advanced age, are associated with detection of adenomas. A correlation has not been established between the two processes however. Adenoma detection rate (ADR) is a widely accepted quality indicator in screening colonoscopies. If a correlation exists between diverticular disease and adenomas, recommendations regarding frequency of surveillance colonoscopies may require revision in select populations. Methods: In a retrospective analysis, we collected data in a single center from 896 patients. Screening and non-screening colonoscopy was performed by one of five experienced gastroenterologists (without the assistance of trainees). Those with Familial Polyposis Syndrome, IBD, colitis, or abnormal anatomy were excluded. Presence of diverticula was noted, and polyps resected were recorded for each patient. Results: 420 (47%) of the 896 patients demonstrated diverticular disease on colonoscopy. ADR was 42% in those with diverticulosis (176/420) as opposed to 24% in those without (114/476) (Figure 1). Age greater than 50 years-old (OR 1.04, 95% CI 1.03 - 1.06) and male gender (OR 1.44, 95% CI 1.07 - 1.93) were associated with increased ADR. The risk of adenoma detection increased by 4% for every passing year in age. After accounting for these two confounders, diverticulosis was found to be a significant predictor of adenomas with an approximately 80% greater likelihood of adenoma detection in those with diverticulosis than those without (OR 1.79, 95% CI 1.32 - 2.41). The side of colon that contained diverticula was compared to the side of colon where polyps were found, with no significant association (P=0.92).FigureConclusion: Diverticulosis was associated with markedly increased ADR even after accounting for age and gender. It may be speculated that presence of diverticulosis prompts the endoscopist to search for further abnormalities. However, the lack of a significant relationship between the side of colon where diverticula were present and the side where polyps were found argues against this assessment. A more likely explanation may be shared risk factors. Diabetes mellitus and smoking have been linked to both disease processes. While further study is needed to elucidate the relationship between diverticulosis and adenomas, the strong association may have implications for colorectal cancer screening.