Asaad Peter, Hajibandeh Shahab, Rahm Mariam, Johnston Theo, Chowdhury Supria, Bronder Christine
Department of General Surgery, Stepping Hill Hospital, Stockport SK2 7JE, United Kingdom.
Department of General Surgery, North Manchester General Hospital, Manchester M8 5RB, United Kingdom.
World J Gastrointest Endosc. 2019 Jul 16;11(7):427-437. doi: 10.4253/wjge.v11.i7.427.
The current guidelines suggest that patients should undergo endoscopic evaluation of the colonic lumen after an episode of computed tomography (CT) proven acute diverticulitis to rule out malignancy. The usefulness of routine endoscopic evaluation of CT proven diverticulitis remains unknown.
To establish whether routine colonoscopy should be offered to patients after an episode of diverticulitis.
We performed a retrospective study, comparing two groups: a diverticulitis group and a control group. The diverticulitis group consisted of patients undergoing a colonoscopy after an episode of diverticulitis. The control group consisted of asymptomatic patients undergoing a screening sigmoidoscopy. We also performed a systematic review and meta-analysis. We searched electronic data resources to identify all relevant studies. The primary outcome was the number of adenomas found, while the secondary outcomes were the number of cancers and polyps identified, and the adenoma risk.
68 and 1309 patients were included in the diverticulitis and control groups respectively. There was no difference in the risk of adenomas (5.9% 7.6%, 0.59), non-advanced adenomas (5.9% 6.9%, 0.75), advanced adenomas (0% 0.8%, 1), cancer (0% 0.15%, 1.00), and polyps (16.2% 14.2%, 0.65) between both groups. Meta-analysis of data from 4 retrospective observational studies, enrolling 4459 patients, showed no difference between the groups in terms of risk of adenomas (RD = -0.05, 95%CI: -0.11, 0.01, 0.10), non-advanced adenomas (RD = -0.02, 95%CI: -0.08, 0.04, 0.44), advanced adenomas (RD = -0.01, 95%CI: -0.04, 0.02, 0.36), cancer (RD = 0.01, 95%CI: -0.01, 0.03, 0.32), and polyps (RD = -0.05, 95%CI: -0.12, 0.02, 0.18).
Routine colonoscopy may not be appropriate in patients with acute diverticulitis. High quality prospective studies are required for more robust conclusions.
当前指南建议，在计算机断层扫描（CT）证实为急性憩室炎发作后，患者应接受结肠腔的内镜评估以排除恶性肿瘤。CT证实的憩室炎进行常规内镜评估的有效性尚不清楚。
确定憩室炎发作后是否应常规为患者提供结肠镜检查。
我们进行了一项回顾性研究，比较了两组：憩室炎组和对照组。憩室炎组由憩室炎发作后接受结肠镜检查的患者组成。对照组由接受乙状结肠镜筛查的无症状患者组成。我们还进行了系统评价和荟萃分析。我们搜索电子数据资源以识别所有相关研究。主要结局是发现的腺瘤数量，次要结局是识别出的癌症和息肉数量以及腺瘤风险。
憩室炎组和对照组分别纳入了68例和1309例患者。两组之间腺瘤风险（5.9%对7.6%，P=0.59）、非进展性腺瘤（5.9%对6.9%，P=0.75）、进展性腺瘤（0%对0.8%，P=1）、癌症（0%对0.15%，P=1.00）和息肉（16.2%对14.2%，P=0.65）均无差异。对纳入4459例患者的4项回顾性观察性研究的数据进行荟萃分析，结果显示两组在腺瘤风险（风险差=-0.05，95%置信区间：-0.11，0.01，P=0.10）、非进展性腺瘤（风险差=-0.02，95%置信区间：-0.08，0.04，P=0.44）、进展性腺瘤（风险差=-0.01，95%置信区间：-0.04，0.02，P=0.36）、癌症（风险差=0.01，95%置信区间：-0.01，0.03，P=0.32）和息肉（风险差=-0.05，95%置信区间：-0.12，0.02，P=0.18）方面无差异。
急性憩室炎患者可能不适合常规结肠镜检查。需要高质量的前瞻性研究得出更可靠的结论。
