Opportunities and risks of colonoscopy in colonic diverticular disease

Abstract

This article analyzes the results of screening, diagnostic, and differential diagnostic colonoscopy. The efficacy of colonoscopy (sensitivity and specificity) in the diagnosis of colonic diverticular disease was determined in relation to pathological processes occurring in the intestinal lumen, its wall, mesentery, and other organs of the abdominal cavity and pelvis. The sensitivity and specificity of colonoscopy in examining the intestinal lumen were 87 and 83 %, respectively, while in examining the intestinal wall, they were 23.03 and 81 %, respectively. With regard to the efficacy of colonoscopies in detecting pathologies of the mesentery and other abdominal and pelvic organs, the results were null. Henceforth, colonoscopy is an informative diagnostic method for pathological processes in the lumen of the large intestine without radiation exposure. During the procedure, video recording with subsequent analysis can be performed, a biopsy can be taken for differential diagnosis, and the source of bleeding can be identified if present. Having said that colonoscopies have several limitations that reduce their effectiveness in cases of complicated colonic diverticular disease. These limitations include the inability to assess the condition of the paracolic tissue, mesentery, or other abdominal and pelvic organs; difficulty in accurately localizing diverticula and inflammatory processes relative to intestinal segments; inability to evaluate the extent of parietal pathological changes; impossibility of examining proximal intestinal segments in cases of stenosis or obstruction of the lower sections; and most importantly, the risk of intestinal wall perforation. Consequently, colonoscopies in cases of diverticular disease should be performed in strict accordance with established indications, which include obtaining biopsy material and identifying the source of the bleeding.