Association between diverticular disease and prevalence of colorectal adenomatous polyps or adenocarcinomas: Diverticular disease and colorectal adenoma/adenocarcinoma

Emre Gerçeker; Ahmed Baykan

doi:10.28982/josam.7552

Authors

Emre Gerçeker Departments of Gastroenterology, Izmir Medicana International Hospital, İzmir, Turkey https://orcid.org/0000-0001-7494-2912
Ahmed Baykan Departments of Gastroenterology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey https://orcid.org/0000-0001-6798-0240

DOI:

https://doi.org/10.28982/josam.7552

Keywords:

Adenomatous polyp, Colon adenocarcinoma, Diverticular disease, High grade dysplasia, Villous adenomatous polyp

Abstract

Background/Aim: Although the link between diverticular disease (DD) of the colon and colon polyp is known, the relationship between colon adenocarcinoma is not clear. This study evaluated the association between DD and adenomatous polyp or colon adenocarcinoma.

Methods: Patients who underwent colonoscopy for the first time in 2020-2021 were evaluated and included in this retrospective cohort study. Patients with a previous history of cancer diagnosis, colon surgery, DD, and inflammatory bowel disease were excluded from the study. Age, gender, colonoscopy indications, colonoscopy diagnoses, presence of DD, characteristics of polyps (pathology, diameter, number, localization), and presence of adenocarcinoma were recorded. Obtained data were analyzed between DD and non-DD groups.

Results: A total of 2633 patients were included in the study. The prevalence of DD was 16.4%. Colon adenocarcinoma was detected in 4.7%. The adenomatous polyp rate was 14.1%. A significantly higher rate of adenomatous polyps was detected in the DD group compared to the non-DD group (19.7% vs. 12.9%; P = 0.001). Higher rates of high-grade dysplasia (3.0 vs. 1.1%; P = 0.002) and colon adenocarcinoma (7.2% vs. 4.2%; P = 0.008) were observed in the DD group also. In logistic regression analyses, it was observed that the presence of concomitant DD increases the risk of adenomatous polyps (OR: 1.469, 95% CI: 1.158–1.865), the risk of adenomatous polyps with positive villous component (OR: 2.378, 95% CI: 1.437–3.934), the risk of adenomatous polyps with high-grade dysplasia (OR: 2.822, 95% CI: 1.426–5.582), and the risk of colon adenocarcinoma (OR: 2.953, 95% CI: 1.445–6.533).

Conclusion: DD is associated with precancerous lesions of the colon (adenomatous polyp, villous adenoma, high-grade dysplasia) and colon adenocarcinoma. Further studies are needed to investigate its association with colon carcinogenesis and its role and value in cancer screening.

Downloads

Download data is not yet available.

References

Katsaounou K, Nicolaou E, Vogazianos P, Brown C, Stavrou M, Teloni S, et al. Colon Cancer: From Epidemiology to Prevention. Metabolites. 2022 May 30;12(6):499. doi: 10.3390/metabo12060499. DOI: https://doi.org/10.3390/metabo12060499

Issa IA, Noureddine M. Colorectal cancer screening: An updated review of the available options. World J Gastroenterol. 2017 Jul 28;23(28):5086-96. doi: 10.3748/wjg.v23.i28.5086. DOI: https://doi.org/10.3748/wjg.v23.i28.5086

Sullivan BA, Noujaim M, Roper J. Cause, Epidemiology, and Histology of Polyps and Pathways to Colorectal Cancer. Gastrointest Endosc Clin N Am. 2022 Apr;32(2):177-94. doi: 10.1016/j.giec.2021.12.001. DOI: https://doi.org/10.1016/j.giec.2021.12.001

Leslie A, Carey FA, Pratt NR, Steele RJ. The colorectal adenoma-carcinoma sequence. Br J Surg. 2002;89(7):845-60. DOI: https://doi.org/10.1046/j.1365-2168.2002.02120.x

Imperiale TF, Juluri R, Sherer EA, Glowinski EA, Johnson CS, Morelli MS. A risk index for advanced neoplasia on the second surveillance colonoscopy in patients with previous adenomatous polyps. Gastrointest Endosc. 2014 Sep;80(3):471-8. DOI: https://doi.org/10.1016/j.gie.2014.03.042

Venugopal A, Carethers JM. Epidemiology and biology of early onset colorectal cancer. EXCLI J. 2022 Jan 7;21:162-82. doi: 10.17179/excli2021-4456. DOI: https://doi.org/10.1016/S0016-5085(22)60527-4

Simon K. Colorectal cancer development and advances in screening. Clin Interv Aging. 2016 Jul 19;11:967-76. doi: 10.2147/CIA.S109285. DOI: https://doi.org/10.2147/CIA.S109285

Hirata T, Kawakami Y, Kinjo N, Arakaki S, Arakaki T, Hokama A, et al. Association between colonic polyps and diverticular disease. World J Gastroenterol. 2008 Apr 21;14(15):2411-3. doi: 10.3748/wjg.14.2411. DOI: https://doi.org/10.3748/wjg.14.2411

Granlund J, Svensson T, Granath F, Hjern F, Ekbom A, Blomqvist P, et al. Diverticular disease and the risk of colon cancer - a population-based case-control study. Aliment Pharmacol Ther. 2011 Sep;34(6):675-81. doi: 10.1111/j.1365-2036.2011.04782.x. DOI: https://doi.org/10.1111/j.1365-2036.2011.04782.x

Mari A, Khoury T, Sbeit W. Post-Diverticulitis Colonoscopy Was Not Associated with Higher Colonic Adenoma and Carcinoma: A Multicenter Case-Control Study. Medicina (Kaunas). 2021 Jul 2;57(7):682. doi: 10.3390/medicina57070682. DOI: https://doi.org/10.3390/medicina57070682

Keum N, Giovannucci E. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nat Rev Gastroenterol Hepatol. 2019 Dec;16(12):713-32. doi: 10.1038/s41575-019-0189-8. DOI: https://doi.org/10.1038/s41575-019-0189-8

Piscopo N, Ellul P. Diverticular Disease: A Review on Pathophysiology and Recent Evidence. Ulster Med J. 2020 Sep;89(2):83-8.

Muhammad A, Lamendola O, Daas A, Kumar A, Vidyarthi G. Association between colonic diverticulosis and prevalence of colorectal polyps. Int J Colorectal Dis. 2014 Aug;29(8):947-51. doi: 10.1007/s00384-014-1908-9. DOI: https://doi.org/10.1007/s00384-014-1908-9

Ashktorab H, Panchal H, Shokrani B, Paydar M, Sanderson A, Lee EL, et al. Association between Diverticular Disease and Pre-Neoplastic Colorectal Lesions in an Urban African-American Population. Digestion. 2015;92(2):60-5. doi: 10.1159/000376574. DOI: https://doi.org/10.1159/000376574

Viscido A, Ciccone F, Vernia F, Association of Colonic Diverticula with Colorectal Adenomas and Cancer. Medicina (Kaunas). 2021 Jan 25;57(2):108. doi: 10.3390/medicina57020108. DOI: https://doi.org/10.3390/medicina57020108

Tomaoglu K. Association Between Colonic Diverticulosis and Colorectal Polyps, Advanced Neoplastic Lesions, and Colorectal Carcinomas: A Cross-Sectional, Retrospective Study. Surg Laparosc Endosc Percutan Tech. 2020 Apr;30(2):196-200. doi: 10.1097/SLE.0000000000000726. DOI: https://doi.org/10.1097/SLE.0000000000000726

Kearney MB, Williams JM, Ebell MH. Colon Cancer and Diverticular Disease Association: a Case-Control Study. J Gastrointest Cancer. 2021 Mar;52(1):120-4. doi: 10.1007/s12029-019-00355-1. DOI: https://doi.org/10.1007/s12029-019-00355-1

Jaruvongvanich V, Sanguankeo A, Wijarnpreecha K, Upala S. Risk of colorectal adenomas, advanced adenomas and cancer in patients with colonic diverticular disease: Systematic review and meta-analysis. Dig Endosc. 2017 Jan;29(1):73-82. doi: 10.1111/den.12701. DOI: https://doi.org/10.1111/den.12701

Abu Baker F, Z’Cruz De La Garza JA, Mari A, Zeina AR, Bishara A, Gal O, et al. Colorectal cancer and polyps in diverticulosis patients: a 10-year retrospective study in 13680 patients. Gastroenterol Res Pract. 2019;2019:2507848. doi: 10.1155/2019/2507848. DOI: https://doi.org/10.1155/2019/2507848

Mortensen LQ, Buciek J, Andresen K, Rosenberg. Diverticulitis does not increase the long-term risk of developing colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis. 2022 Sep;37(9):1945-52. doi: 10.1007/s00384-022-04246-z. DOI: https://doi.org/10.1007/s00384-022-04246-z

Huang WY, Lin CC, Jen YM, Chang YJ, Hsiao CW, Yang MH, et al. Association between colonic diverticular disease and colorectal cancer: a nationwide population-based study. Clin Gastroenterol Hepatol. 2014 Aug;12(8):1288-94. doi: 10.1016/j.cgh.2013.11.039. DOI: https://doi.org/10.1016/j.cgh.2013.11.039

Ekbom A. Is diverticular disease associated with colonic malignancy? Dig Dis. 2012;30(1):46-50. doi: 10.1159/000335708. DOI: https://doi.org/10.1159/000335708

Meurs-Szojda MM, Terhaar sive Droste JS, Kuik DJ, Mulder CJ, Felt-Bersma RJ. Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4,241 colonoscopies. Int J Colorectal Dis. 2008 Oct;23(10):979-84. doi: 10.1007/s00384-008-0510-4. DOI: https://doi.org/10.1007/s00384-008-0510-4

Cappell MS. Pathophysiology, clinical presentation, and management of colon cancer. Gastroenterol Clin North Am. 2008 Mar;37(1):1-24. doi: 10.1016/j.gtc.2007.12.002. DOI: https://doi.org/10.1016/j.gtc.2007.12.002

Barbaro MR, Cremon C, Fuschi D, Marasco G, Palombo M, Stanghellini V, et al. Pathophysiology of Diverticular Disease: From Diverticula Formation to Symptom Generation. Int J Mol Sci. 2022 Jun 15;23(12):6698. doi: 10.3390/ijms23126698. DOI: https://doi.org/10.3390/ijms23126698

Nguyen LH, Goel A, Chung DC. Pathways of Colorectal Carcinogenesis. Gastroenterology. 2020 Jan;158(2):291-302. doi: 10.1053/j.gastro.2019.08.059. DOI: https://doi.org/10.1053/j.gastro.2019.08.059