A novel endoscopic grading system for prediction of disease-related outcomes in patients with diverticulosis

Abstract

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.

Keywords: Colonoscopy; Diverticular disease; Diverticulitis; Diverticulosis; Endoscopy.