Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK.
Surg Endosc. 2023 Jul;37(7):5114-5120. doi: 10.1007/s00464-023-09997-6. Epub 2023 Mar 17.
Acute diverticulitis (AD) is a common cause of presentation to emergency surgical services. Follow-up with endoluminal investigation to exclude colorectal cancer (CRC) remains controversial. Guidelines are increasingly moving to a more restrictive follow-up based on severity of disease and age. The purpose of this observational study was to assess the prevalence of CRC in AD patients and the impact of follow-up on endoscopy services.
Patients admitted with a diagnosis of AD over a 2-year period were reviewed. The proportion of patients undergoing endoscopic follow-up and the CRC detection rate were recorded. The potential impact of a more conservative approach to follow-up was evaluated.
There were 484 patients with AD presenting 546 times (M:F = 198:286; median age = 63 years). 80% of admissions were aged 50 or older. There were 43 emergency interventions in 39 patients (10 percutaneous drain; 33 surgery). The remainder were managed conservatively. 28 patients (5.1%) underwent colonic resection with cancer found in one specimen (3.6%). 287 patients underwent endoluminal follow-up with cancer diagnosed in 3 cases (1.0%). There was no significant difference in the prevalence of CRC between patients requiring emergency surgery and those managed conservatively, or between patients with complicated versus uncomplicated diverticulitis.
CRC masquerading as acute diverticulitis is rare. The incidence of neoplasia both at endoscopic follow-up and in patients requiring emergency intervention is low. Conservative follow-up strategies appear safe, but their effectiveness in reducing the burden on endoscopy services may be limited by current age-based recommendations. Restricting follow-up to those with complicated AD would reduce the number of patients requiring endoluminal investigation by 70%.
急性憩室炎（AD）是急诊外科服务的常见病因。对结直肠癌（CRC）进行内镜下检查以排除该疾病的随访仍存在争议。指南越来越倾向于根据疾病严重程度和年龄进行更严格的随访。本观察性研究的目的是评估 AD 患者中 CRC 的患病率，以及随访对内镜服务的影响。
回顾了在两年内因 AD 诊断而入院的患者。记录接受内镜随访的患者比例和 CRC 检出率。评估更保守的随访方法的潜在影响。
共有 484 例 AD 患者就诊 546 次（M:F=198:286；中位年龄 63 岁）。80%的入院患者年龄在 50 岁或以上。39 例患者中有 43 例（10 例经皮引流；33 例手术）进行了紧急干预。其余患者采用保守治疗。1 例标本发现癌症，有 28 例（5.1%）患者接受了结肠切除术。287 例患者接受了内镜随访，3 例（1.0%）诊断为癌症。需要紧急手术和采用保守治疗的患者，以及复杂性和非复杂性憩室炎患者之间，CRC 的患病率无显著差异。
CRC 伪装成急性憩室炎的情况很少见。内镜随访和需要紧急干预的患者中肿瘤的发生率均较低。保守的随访策略似乎是安全的，但由于目前基于年龄的建议，其在减轻内镜服务负担方面的有效性可能有限。将随访限制在复杂性 AD 患者中，将使需要内镜检查的患者数量减少 70%。
