Chin Koon Siw Kevin, Engel Jake, Visva Samantha, Mallick Ranjeeta, Hart Ailsa, de Buck van Overstraeten Anthony, McCurdy Jeffrey D
Division of Gastroenterology and Hepatology, University of Ottawa, Ottawa, ON, Canada.
Faculty of Medicine, University of Ottawa, ON, Canada.
Inflamm Bowel Dis. 2022 Sep 1;28(9):1363-1374. doi: 10.1093/ibd/izab286.
Management of perianal fistulas differs based on fistula type. We aimed to assess the ability of diagnostic strategies to differentiate between Crohn's disease (CD) and cryptoglandular disease (CGD) in patients with perianal fistulas.
We performed a diagnostic accuracy systematic review and meta-analysis. A systematic search of electronic databases was performed from inception through February 2021 for studies assessing a diagnostic test's ability to distinguish fistula types. We calculated weighted summary estimates with 95% confidence intervals for sensitivity and specificity by bivariate analysis, using fixed effects models when data were available from 2 or more studies. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess study quality.
Twenty-one studies were identified and included clinical symptoms (2 studies; n=154), magnetic resonance imaging (MRI) characteristics (3 studies; n=296), ultrasound characteristics (7 studies; n=1003), video capsule endoscopy (2 studies; n=44), fecal calprotectin (1 study; n=56), and various biomarkers (8 studies; n=440). MRI and ultrasound characteristics had the most robust data. Rectal inflammation, multiple-branched fistula tracts, and abscesses on pelvic MRI and the Crohn's ultrasound fistula sign, fistula debris, and bifurcated fistulas on pelvic ultrasonography had high specificity (range, 80%-95% vs 89%-96%) but poor sensitivity (range, 17%-37% vs 31%-63%), respectively. Fourteen of 21 studies had risk of bias on at least 1 of the Quality Assessment of Diagnostic Accuracy Studies domains.
Limited high-quality evidence suggest that imaging characteristics may help discriminate CD from CGD in patients with perianal fistulas. Larger, prospective studies are needed to confirm these findings and to evaluate if combining multiple diagnostic tests can improve diagnostic sensitivity.
肛周瘘管的治疗因瘘管类型而异。我们旨在评估诊断策略区分肛周瘘管患者克罗恩病（CD）和隐窝腺性疾病（CGD）的能力。
我们进行了一项诊断准确性的系统评价和荟萃分析。从数据库建立至2021年2月，对电子数据库进行系统检索，以查找评估诊断试验区分瘘管类型能力的研究。通过双变量分析计算敏感性和特异性的加权汇总估计值及95%置信区间，当有两项或更多研究的数据时使用固定效应模型。使用诊断准确性研究质量评估工具评估研究质量。
共纳入21项研究，包括临床症状（2项研究；n = 154）、磁共振成像（MRI）特征（3项研究；n = 296）、超声特征（7项研究；n = 1003）、视频胶囊内镜检查（2项研究；n = 44）、粪便钙卫蛋白（1项研究；n = 56）以及各种生物标志物（8项研究；n = 440）。MRI和超声特征的数据最为充分。盆腔MRI上的直肠炎症、多分支瘘管和脓肿以及盆腔超声检查中的克罗恩超声瘘管征、瘘管碎片和分叉瘘管具有较高的特异性（范围分别为80% - 95%和89% - 96%），但敏感性较差（范围分别为17% - 37%和31% - 63%）。21项研究中有14项在诊断准确性研究质量评估的至少一个领域存在偏倚风险。
有限的高质量证据表明，影像学特征可能有助于区分肛周瘘管患者的CD和CGD。需要开展更大规模的前瞻性研究来证实这些发现，并评估联合多种诊断试验是否能提高诊断敏感性。
