Abstract：
Traditionally, international guidelines recommend patients with acute diverticulitis should be followed up with a colonoscopy 6-8 weeks after discharge. However, the need for an interval colonoscopy has been increasingly challenged in the setting of computed tomography (CT). Previous meta-analyses have included studies which combined suspected rather than imaging confirmed diverticulitis and often without correlation with endoscopic findings. This meta-analysis aims to investigate endoscopic findings of patients with CT confirmed diverticulitis.
An electronic search of Medline, PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus, Clinicaltrials.gov and WHO ICTRP was performed up to October 18, 2021. Studies which reported CT confirmed acute diverticulitis in adults and who underwent endoscopic follow-up with either a colonoscopy or flexible sigmoidoscopy were included. Studies were excluded if diverticulitis was diagnosed by clinical grounds alone, ultrasound, barium enema, or other non-CT forms of imaging.
A total of 68 studies with 13 905 patients were included. Median age was 58 years and male to female ratio was 0.84. Cancer was detected in 2.0% and advanced adenoma in 3.8%. Complicated diverticulitis had 9.2 higher odds of cancer compared to uncomplicated diverticulitis (95% CI 4.42-19.08, P < 0.001). Adenomas were detected in 17%. Of those diagnosed with colorectal cancer, 85% were concordant with the site of the diverticulitis on CT while 15% were incidental findings.
Routine colonoscopic follow up should be recommended in medically fit patients who have CT proven acute diverticulitis due to the higher than population prevalence of colorectal cancer and advanced adenomas.
An electronic search of Medline, PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus, Clinicaltrials.gov and WHO ICTRP was performed up to October 18, 2021. Studies which reported CT confirmed acute diverticulitis in adults and who underwent endoscopic follow-up with either a colonoscopy or flexible sigmoidoscopy were included. Studies were excluded if diverticulitis was diagnosed by clinical grounds alone, ultrasound, barium enema, or other non-CT forms of imaging.
A total of 68 studies with 13 905 patients were included. Median age was 58 years and male to female ratio was 0.84. Cancer was detected in 2.0% and advanced adenoma in 3.8%. Complicated diverticulitis had 9.2 higher odds of cancer compared to uncomplicated diverticulitis (95% CI 4.42-19.08, P < 0.001). Adenomas were detected in 17%. Of those diagnosed with colorectal cancer, 85% were concordant with the site of the diverticulitis on CT while 15% were incidental findings.
Routine colonoscopic follow up should be recommended in medically fit patients who have CT proven acute diverticulitis due to the higher than population prevalence of colorectal cancer and advanced adenomas.
摘要：
背景：传统上，国际指南建议急性憩室炎患者应在出院后6~8周进行结肠镜检查随访.然而,在计算机断层扫描(CT)的背景下,对间期结肠镜检查的需求日益受到挑战.以前的荟萃分析包括结合可疑而不是影像学证实的憩室炎的研究，并且通常与内窥镜检查结果无关。这项荟萃分析旨在调查CT证实的憩室炎患者的内镜检查结果。
方法：Medline的电子搜索，PubMed,科克伦图书馆,Embase,CINAHL,WebofScience,Scopus,Clinicaltrials.gov和WHOICTRP的执行时间截至2021年10月18日。包括报告CT证实成人急性憩室炎的研究，并接受了结肠镜检查或软式乙状结肠镜检查的内窥镜随访。如果仅根据临床诊断憩室炎，则排除研究。超声，钡灌肠,或其他非CT形式的成像。
结果：共纳入68项研究，共13905例患者。中位年龄为58岁，男女比例为0.84。在2.0％中检测到癌症，在3.8％中检测到晚期腺瘤。与无并发症憩室炎相比，复杂憩室炎患癌症的几率高9.2（95％CI4.42-19.08，P<0.001）。在17%中检测到腺瘤。在那些被诊断患有结直肠癌的人中，85％与CT上的憩室炎部位一致，而15％是偶然发现。
结论：由于结直肠癌和晚期腺瘤的患病率高于人群，CT证实为急性憩室炎的患者应进行常规结肠镜检查随访。
方法：Medline的电子搜索，PubMed,科克伦图书馆,Embase,CINAHL,WebofScience,Scopus,Clinicaltrials.gov和WHOICTRP的执行时间截至2021年10月18日。包括报告CT证实成人急性憩室炎的研究，并接受了结肠镜检查或软式乙状结肠镜检查的内窥镜随访。如果仅根据临床诊断憩室炎，则排除研究。超声，钡灌肠,或其他非CT形式的成像。
结果：共纳入68项研究，共13905例患者。中位年龄为58岁，男女比例为0.84。在2.0％中检测到癌症，在3.8％中检测到晚期腺瘤。与无并发症憩室炎相比，复杂憩室炎患癌症的几率高9.2（95％CI4.42-19.08，P<0.001）。在17%中检测到腺瘤。在那些被诊断患有结直肠癌的人中，85％与CT上的憩室炎部位一致，而15％是偶然发现。
结论：由于结直肠癌和晚期腺瘤的患病率高于人群，CT证实为急性憩室炎的患者应进行常规结肠镜检查随访。
