Azizian John M, Trieu Harry, Kovacs Thomas O, Turkiewicz Joanna, Hilder Robin, Palmer Samantha, Roux Michelle Le, Dong Tien, Berry Rani, Beaven Simon W, Tabibian James H
UCLA-Olive View Internal Medicine Residency Program, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA.
Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Tech Innov Gastrointest Endosc. 2022;24(3):254-261. doi: 10.1016/j.tige.2022.04.001. Epub 2022 Apr 18.
Colonoscopy is recommended post-acute diverticulitis (AD) to exclude underlying adenocarcinoma (CRC). However, post-AD colonoscopy utility remains controversial. We aimed to examine yield of post-AD colonoscopy in our majority-Hispanic patient population.
Patients undergoing post-AD colonoscopy between 11/1/2015-7/31/2021 were identified from a prospectively maintained endoscopic database. AD cases without computed tomography confirmation were excluded. Pertinent data, including complicated vs uncomplicated AD, fecal immunochemical test (FIT) result post-AD/pre-colonoscopy, and number/type/location of non-advanced adenomas, advanced adenomas, and CRC, were abstracted. Analyses were conducted using two-sample Wilcoxon rank-sum and Fisher's exact tests.
208 patients were included, of whom 62.0% had uncomplicated AD. Median age was 53, 54.3% were female, and 77.4% were Hispanic. Ninety non-advanced adenomas were detected in 45 patients (21.6%), in addition to advanced adenoma in eight patients (3.8%). Two patients (1.0%) had CRC, both of whom had complicated AD in the same location seen on imaging, and one of whom was FIT+ (the other had not undergone FIT). Patients with uncomplicated versus complicated AD had similarly low rates of advanced adenomas (4.7% vs. 2.5%, p=0.713). FIT data were available in 51 patients and positive in three (5.9%); non-advanced adenomas were found in all three FIT+ patients. No FIT- patient had an advanced adenoma or CRC.
Colonoscopy post-AD is generally low yield, with CRC being rare and found only in those with complicated AD. Colonoscopy post-complicated AD appears advisable, whereas less invasive testing (e.g. FIT) may be considered post-uncomplicated AD to inform the need for colonoscopy.
急性憩室炎（AD）后推荐进行结肠镜检查以排除潜在的腺癌（CRC）。然而，AD后结肠镜检查的效用仍存在争议。我们旨在研究在我们以西班牙裔为主的患者群体中AD后结肠镜检查的检出率。
从一个前瞻性维护的内镜数据库中识别出2015年11月1日至2021年7月31日期间接受AD后结肠镜检查的患者。排除没有计算机断层扫描确认的AD病例。提取相关数据，包括复杂性与非复杂性AD、AD后/结肠镜检查前的粪便免疫化学检测（FIT）结果，以及非高级别腺瘤、高级别腺瘤和CRC的数量/类型/位置。使用两样本Wilcoxon秩和检验和Fisher精确检验进行分析。
纳入208例患者，其中62.0%患有非复杂性AD。中位年龄为53岁，54.3%为女性，77.4%为西班牙裔。45例患者（21.6%）检测到90个非高级别腺瘤，另外8例患者（3.8%）检测到高级别腺瘤。2例患者（1.0%）患有CRC，两者在影像学上显示相同位置的复杂性AD，其中1例FIT呈阳性（另1例未进行FIT）。非复杂性与复杂性AD患者的高级别腺瘤发生率同样较低（4.7%对2.5%，p = 0.713）。51例患者有FIT数据，3例呈阳性（5.9%）；所有3例FIT阳性患者均发现非高级别腺瘤。没有FIT阴性患者患有高级别腺瘤或CRC。
AD后结肠镜检查的总体检出率较低，CRC罕见，仅在复杂性AD患者中发现。复杂性AD后进行结肠镜检查似乎是可取的，而对于非复杂性AD，可考虑采用侵入性较小的检测方法（如FIT）来确定是否需要进行结肠镜检查。
