Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel, Affiliated to the Technion Faculty of Medicine, Haifa, Israel.
Department of internal medicine, Hillel Yaffe Medical Center, Hadera, Israel, Affiliated to the Technion Faculty of Medicine, Haifa, Israel.
Medicine (Baltimore). 2021 Feb 5;100(5):e24271. doi: 10.1097/MD.0000000000024271.
Recent reports have documented an unchanged rate of occurrence of colorectal cancer (CRC) and have publicised doubts regarding the benefit of prompt colonoscopy procedures after an episode of acute diverticulitis (AD). These reports mandate further evaluation of colonoscopy yield and timing in this regard. The current study aims to determine whether the rate of advanced colonic neoplasia after AD differs from that of average-risk patients, and to identify risk factors that are associated with their development.In this retrospective study, we included all patients who had been hospitalized to the surgery ward in the years 2008 to 2016 with radiographically confirmed AD, and had completed colonoscopies within one year of index hospitalization. Patients who were referred for screening colonoscopies during the same years were included as a control group. We compared the rates of diagnosis of CRC and advanced polyps for both groups before and after adjustment for multiple confounders. Moreover, we investigated risk factors that were associated with increased rate of advanced neoplasia diagnosis.A total of 350 patients were included in the AD group and 1502 patients in the screening colonoscopy control group. The CRC diagnosis rates (1.7% vs 0.3%; P = .09) and overall diagnosis rates of advanced neoplasia (12.3% vs 9.6%; P = .19) were not significantly different when findings were compared between the AD and control groups, respectively. Cases of complicated diverticulitis, however, were associated with increased risk of advanced neoplasia diagnosis (odds ratio (OR) 3.729, 95% confidence interval (CI) 1.803-7.713; P = .01).The diagnosis rate for advanced neoplasia after AD was not significantly different from that of average-risk populations. A course of complicated AD, however, was a potential risk factor.
最近的报告记录了结直肠癌症（CRC）的发生率保持不变，并对急性憩室炎（AD）发作后及时进行结肠镜检查的益处提出了质疑。这些报告要求进一步评估这方面的结肠镜检查结果和时间。本研究旨在确定 AD 后进展性结肠肿瘤的发生率是否与普通风险患者不同，并确定与发展相关的危险因素。
在这项回顾性研究中，我们纳入了 2008 年至 2016 年期间因放射学确诊的 AD 住院至外科病房的所有患者，且在索引住院后一年内完成了结肠镜检查。在同一时期因筛查性结肠镜检查而转诊的患者被纳入对照组。我们比较了两组患者在调整了多种混杂因素前后诊断 CRC 和高级息肉的比率。此外，我们还研究了与高级肿瘤发生率增加相关的危险因素。
共有 350 例患者纳入 AD 组，1502 例患者纳入筛查结肠镜对照组。当分别比较 AD 组和对照组时，CRC 诊断率（1.7%比 0.3%；P=0.09）和高级肿瘤总体诊断率（12.3%比 9.6%；P=0.19）均无显著差异。然而，复杂憩室炎的病例与高级肿瘤诊断风险增加相关（优势比（OR）3.729，95%置信区间（CI）1.803-7.713；P=0.01）。
AD 后高级肿瘤的诊断率与普通风险人群无显著差异。然而，复杂的 AD 病程是一个潜在的危险因素。
