Should a colonoscopy be offered routinely to patients with CT proven acute diverticulitis? A retrospective cohort study and meta-analysis of best available evidence  

作　　者：Peter Asaad Shahab Hajibandeh Mariam Rahm Theo Johnston Supria Chowdhury Christine Bronder 

机构地区：[1]Department of General Surgery, Stepping Hill Hospital, Stockport SK2 7JE, United Kingdom [2]Department of General Surgery, North Manchester General Hospital, Manchester M8 5RB, United Kingdom [3]Department of General and Colorectal Surgery, Royal Lancaster Infirmary, Lancaster LA1 4RP, United Kingdom

出　　处：《World Journal of Gastrointestinal Endoscopy》2019年第7期427-437,共11页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：BACKGROUND The current guidelines suggest that patients should undergo endoscopic evaluation of the colonic lumen after an episode of computed tomography (CT) proven acute diverticulitis to rule out malignancy. The usefulness of routine endoscopic evaluation of CT proven diverticulitis remains unknown. AIM To establish whether routine colonoscopy should be offered to patients after an episode of diverticulitis. METHODS We performed a retrospective study, comparing two groups: a diverticulitis group and a control group. The diverticulitis group consisted of patients undergoing a colonoscopy after an episode of diverticulitis. The control group consisted of asymptomatic patients undergoing a screening sigmoidoscopy. We also performed a systematic review and meta-analysis. We searched electronic data resources to identify all relevant studies. The primary outcome was the number of adenomas found, while the secondary outcomes were the number of cancers and polyps identified, and the adenoma risk. RESULTS 68 and 1309 patients were included in the diverticulitis and control groups respectively. There was no difference in the risk of adenomas (5.9% vs 7.6%, P =0.59), non-advanced adenomas (5.9% vs 6.9%, P = 0.75), advanced adenomas (0% vs 0.8%, P = 1), cancer (0% vs 0.15%, P = 1.00), and polyps (16.2% vs 14.2%, P = 0.65) between both groups. Meta-analysis of data from 4 retrospective observational studies, enrolling 4459 patients, showed no difference between the groups in terms of risk of adenomas (RD =-0.05, 95%CI:-0.11, 0.01, P = 0.10), non-advanced adenomas (RD =-0.02, 95%CI:-0.08, 0.04, P = 0.44), advanced adenomas (RD =-0.01, 95%CI:-0.04, 0.02, P = 0.36), cancer (RD = 0.01, 95%CI:- 0.01, 0.03, P = 0.32), and polyps (RD =-0.05, 95%CI:-0.12, 0.02, P = 0.18). CONCLUSION Routine colonoscopy may not be appropriate in patients with acute diverticulitis. High quality prospective studies are required for more robust conclusions.BACKGROUND The current guidelines suggest that patients should undergo endoscopic evaluation of the colonic lumen after an episode of computed tomography(CT)proven acute diverticulitis to rule out malignancy. The usefulness of routine endoscopic evaluation of CT proven diverticulitis remains unknown.AIM To establish whether routine colonoscopy should be offered to patients after an episode of diverticulitis.METHODS We performed a retrospective study, comparing two groups: a diverticulitis group and a control group. The diverticulitis group consisted of patients undergoing a colonoscopy after an episode of diverticulitis. The control group consisted of asymptomatic patients undergoing a screening sigmoidoscopy. We also performed a systematic review and meta-analysis. We searched electronic data resources to identify all relevant studies. The primary outcome was the number of adenomas found, while the secondary outcomes were the number of cancers and polyps identified, and the adenoma risk.RESULTS68 and 1309 patients were included in the diverticulitis and control groups respectively. There was no difference in the risk of adenomas(5.9% vs 7.6%, P =0.59), non-advanced adenomas(5.9% vs 6.9%, P = 0.75), advanced adenomas(0%vs 0.8%, P = 1), cancer(0% vs 0.15%, P = 1.00), and polyps(16.2% vs 14.2%, P =0.65) between both groups. Meta-analysis of data from 4 retrospective observational studies, enrolling 4459 patients, showed no difference between the groups in terms of risk of adenomas(RD =-0.05, 95%CI:-0.11, 0.01, P = 0.10),non-advanced adenomas(RD =-0.02, 95%CI:-0.08, 0.04, P = 0.44), advanced adenomas(RD =-0.01, 95%CI:-0.04, 0.02, P = 0.36), cancer(RD = 0.01, 95%CI:-0.01, 0.03, P = 0.32), and polyps(RD =-0.05, 95%CI:-0.12, 0.02, P = 0.18).CONCLUSION Routine colonoscopy may not be appropriate in patients with acute diverticulitis.High quality prospective studies are required for more robust conclusions.

关 键 词：DIVERTICULITIS COLON cancer Screening  COLONOSCOPY SIGMOIDOSCOPY 

分 类 号：R[医药卫生]