Cerdán Santacruz Carlos, Muriel Álvarez Pablo, Roig Ferreruela Gonzalo, Merichal Resina Mireia, Pinillos Somalo Ana Isabel, Mestres Petit Nuria, Sierra Grañón José Enrique, Olsina Kissler Jorge Juan
Colorectal Surgery Unit, General Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain.
Universidad de Lleida, Lleida, Spain.
Surg Endosc. 2021 Dec;35(12):6819-6826. doi: 10.1007/s00464-020-08187-y. Epub 2021 Jan 4.
Although included in some guidelines, the recommendation of interval colonoscopy after an acute diverticulitis (AD) episode has recently been questioned. In this study, we evaluated the incidence of colon cancer during the follow-up of an episode of AD.
A retrospective review was carried out of patients with conservatively treated AD at our Institution (January 2011 to December 2018) with or without endoscopic study. Patients who had no colonoscopy performed were followed for two years. The demographic, clinical, radiological, follow-up and anatomopathological records were analysed. We determined CT scan validity for the differential diagnosis of CC and AD; sensibility, specificity, predictive values and likelihood ratios were calculated. Patients lost to follow-up and patients who had had colonoscopy in the previous three years were excluded.
This study included 285 patients with a mean age of 59 years. A total of 225 interval colonoscopies were performed and 60 patients without colonoscopy were followed up. There were 19 CC (6.7%) diagnosed, 14 with interval colonoscopy and 5 during follow-up; 8 (42.1%) happened in patients who had had an episode of uncomplicated AD. Although CT scan accuracy is high, 87.7%, positive and negative likelihood ratios were low, 4.67 and 0.64, respectively.
Interval colonoscopy should still be advisable after an episode of AD. The rationale for this statement is based on a non-negligible rate of hidden CC and an important uncertainty in the differential diagnosis.
尽管急性憩室炎（AD）发作后的间隔结肠镜检查建议已被纳入一些指南，但最近受到了质疑。在本研究中，我们评估了AD发作随访期间结肠癌的发病率。
对我院（2011年1月至2018年12月）接受保守治疗的AD患者进行回顾性研究，无论是否进行内镜检查。未进行结肠镜检查的患者随访两年。分析人口统计学、临床、放射学、随访和解剖病理学记录。我们确定了CT扫描对结肠癌（CC）和AD鉴别诊断的有效性；计算了敏感性、特异性、预测值和似然比。排除失访患者和过去三年接受过结肠镜检查的患者。
本研究纳入285例患者，平均年龄59岁。共进行了225次间隔结肠镜检查，60例未进行结肠镜检查的患者接受了随访。诊断出19例CC（6.7%），14例通过间隔结肠镜检查诊断，5例在随访期间诊断；8例（42.1%）发生在无并发症AD发作的患者中。尽管CT扫描准确性较高，为87.7%，但阳性和阴性似然比分别较低，为4.67和0.64。
AD发作后仍建议进行间隔结肠镜检查。这一说法的依据是隐匿性CC的发生率不可忽视，以及鉴别诊断中存在重要的不确定性。
