Department of Surgery (Division of Vascular Surgery), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Department of General Surgery, University Hospitals of Leicester, UK.
Eur J Vasc Endovasc Surg. 2018 Jul;56(1):22-30. doi: 10.1016/j.ejvs.2018.02.008. Epub 2018 Mar 17.
Colonic ischaemia (CI) is a devastating complication after abdominal aortic aneurysm (AAA) surgery. The aim of this review was to evaluate the diagnostic test accuracy of routine endoscopy in diagnosing CI after treatment for elective and acute AAA.
The Pubmed and Embase database searches resulted in 1188 articles. Prospective studies describing routine post-operative colonoscopy or sigmoidoscopy after elective or emergency AAA repair were included. The study quality was assessed with the QUADAS-2 tool. Sensitivity and specificity forest plots were drawn. Diagnostic odds ratios were calculated by a random effect model.
Twelve articles were included consisting of 718 AAA patients of whom 44% were treated electively, 56% ruptured and, 6% by endovascular repair. Of all patients, 20.8% were identified with CI (all grades), and 6.5% of patients had Grade 3 CI. The pooled diagnostic odds ratio for all grades of CI on endoscopy was 26.60 (95% CI 8.86-79.88). The sensitivity and specificity of endoscopy for detection of Grade 3 CI after AAA repair was 0.52 (95% CI, 0.31-0.73) and 0.97 (95% CI 0.95-0.99) respectively. The positive post-test probability is up to 60% in all kinds of AAA patients and 68% in ruptured AAA patients.
Routine endoscopy is highly accurate for ruling out CI after AAA repair. Clinicians should be aware that endoscopy is less accurate in diagnosing the presence of the clinically relevant transmural CI. Endoscopy is a safe diagnostic test to use routinely as none of the studies reported adverse events.
结肠缺血（CI）是腹主动脉瘤（AAA）手术后一种毁灭性的并发症。本研究旨在评估常规内镜在诊断择期和急性 AAA 治疗后 CI 的诊断试验准确性。
Pubmed 和 Embase 数据库检索共得到 1188 篇文章。纳入描述择期或紧急 AAA 修复后常规术后结肠镜或乙状结肠镜检查的前瞻性研究。使用 QUADAS-2 工具评估研究质量。绘制敏感性和特异性森林图。使用随机效应模型计算诊断比值比。
共纳入 12 项研究，包括 718 例 AAA 患者，其中 44%为择期治疗，56%破裂，6%行血管内修复。所有患者中有 20.8%（所有级别）被诊断为 CI，6.5%的患者为 3 级 CI。内镜检查诊断所有级别 CI 的汇总诊断比值比为 26.60（95%CI 8.86-79.88）。内镜检查诊断 AAA 修复后 3 级 CI 的敏感性和特异性分别为 0.52（95%CI 0.31-0.73）和 0.97（95%CI 0.95-0.99）。所有类型 AAA 患者的阳性后验概率高达 60%，破裂 AAA 患者的阳性后验概率高达 68%。
常规内镜检查对排除 AAA 修复后 CI 非常准确。临床医生应注意，内镜检查在诊断具有临床意义的透壁性 CI 方面准确性较低。由于没有研究报告不良事件，内镜检查是一种安全的诊断测试，可以常规使用。
