Endoscopic findings of diverticular inflammation in colonoscopy patients without clinical acute diverticulitis: Prevalence and endoscopic spectrum

OBJECTIVE: Experienced colonoscopists sometimes encounter endoscopic findings of diverticular inflammation in patients without clinical evidence of acute diverticulitis. Our aim was to describe the spectrum and prevalence of such endoscopic findings in a consecutive series of patients undergoing colonoscopy. METHODS: During elective colonoscopy performed by a single endoscopist on 2566 consecutive outpatients, 21 patients were identified with endoscopic evidence of diverticular inflammation. RESULTS: Endoscopic findings included erythema and edema of a diverticular opening (n = 8), pus emanating from a diverticular orifice (n = 8), and a polypoid mass of granulation tissue in a diverticular orifice (n = 15). Follow-up was obtained by telephone in 17 patients at a mean of 11.9 months after colonoscopy. Only one patient had symptoms of diverticulitis at the time of colonoscopy. This patient improved with antibiotic therapy. Six of the 21 patients had experienced symptoms of abdominal pain or fever, but only one had a diagnosed episode of acute diverticulitis before colonoscopy. None of the patients had acute diverticulitis during the follow-up interval. CONCLUSIONS: Endoscopic findings of diverticular inflammation were identified in about 0.8% of patients undergoing colonoscopy without clinical evidence of diverticulitis. Most patients are asymptomatic at the time of colonoscopy, and antibiotic therapy is generally unnecessary.