Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 110-744, Korea,
Dig Dis Sci. 2014 Sep;59(9):2236-42. doi: 10.1007/s10620-014-3151-1. Epub 2014 Apr 11.
Although colonoscopy verification is warranted after an acute event of diverticulitis to exclude underlying malignancy, little evidence is available to support the recommendations.
The aim of this study was to examine whether subsequent colonoscopy is warranted in patients with diverticulitis on computed tomography (CT).
The study was composed of patients diagnosed with acute diverticulitis on CT scan from January 2001 to March 2013. Patients who had subsequent colonoscopy within a year from the date of CT were included. For each diverticulitis case, two age- (± 5 years) and sex-matched controls were identified from healthy individuals who had received screening colonoscopy. We evaluated the diagnostic yield of advanced colonic neoplasia in colonoscopy.
One hundred and forty-nine patients underwent subsequent colonoscopy within a year from the date of CT. Among the patients, 11 (7.4 %) had colon cancer and 5 (3.4 %) had advanced adenoma. A case-control study revealed that the odds of detecting an advanced neoplasia among patients with diverticulitis on CT were approximately 8.8 times greater than in the age- and sex-matched controls [OR 8.84; 95 % CI 2.90-26.96; p < 0.001]. On analysis of the diverticulitis group, age (≥ 50 years) is an independent risk factor for detecting advanced colonic neoplasia.
The yield of advanced colonic neoplasia was substantially higher in patients with acute diverticulitis than in asymptomatic, average-risk individuals. Colonoscopy verification is warranted in patients with diverticulitis detected on CT, especially in those aged 50 years or older.
尽管结肠镜检查可用于验证急性憩室炎是否存在潜在恶性肿瘤，但目前几乎没有证据支持这一建议。
本研究旨在探讨 CT 扫描诊断为憩室炎的患者是否需要进一步行结肠镜检查。
本研究纳入了 2001 年 1 月至 2013 年 3 月期间 CT 扫描诊断为急性憩室炎的患者。纳入标准为 CT 检查后 1 年内接受了结肠镜检查的患者。为每个憩室炎病例，从接受筛查性结肠镜检查的健康个体中匹配年龄（± 5 岁）和性别相同的 2 名对照者。我们评估了结肠镜检查对进展期结直肠肿瘤的诊断价值。
149 例患者在 CT 检查后 1 年内接受了结肠镜检查。其中 11 例（7.4%）患者患有结肠癌，5 例（3.4%）患者患有高级别腺瘤。病例对照研究显示，与 CT 扫描诊断为憩室炎的患者相比，年龄和性别匹配的对照组中检出高级别肿瘤的可能性约为 8.8 倍[比值比（OR）8.84；95%置信区间（CI）2.90-26.96；p<0.001]。在对憩室炎组的分析中，年龄（≥50 岁）是检出高级别结直肠肿瘤的独立危险因素。
与无症状、一般风险个体相比，急性憩室炎患者进展期结直肠肿瘤的检出率明显更高。CT 扫描诊断为憩室炎的患者需要进一步行结肠镜检查，尤其是年龄≥50 岁的患者。
