CONFOCAL LASER ENDOMICROSCOPY IN THE COLONIC MUCOSA OF PATIENTS WITH DIVERTICULAR DISEASE: INTERIM RESULTS
Presentation Number: 156View Presentation
AuthorBlock: Carlos Robles-Medranda1, Roberto Oleas1, Carlos Cifuentes1, Miguel Puga-Tejada1, Juan Manuel Alcívar-Vásquez1, Haydee Alvarado1, Raquel Salome Del Valle1, Hannah Pitanga Lukashok1
1Endoscopy, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Guayas, Ecuador;
Introduction: Colonic diverticular disease is a prevalent condition in the western hemisphere. Probe-based confocal laser endomicroscopy (pCLE) detects inflammatory changes undetectable during high-definition colonoscopy. However, there is no data regarding the role of peri-diverticular and colonic mucosal inflammation in patients with colonic diverticular disease. We aimed to describe the role of peri-diverticular and colonic mucosal in patients with colonic diverticular disease using confocal laser endomicroscopy.
Methods: an observational, prospective, single-center trial. Consecutive patients evaluated with colonoscopy for screening and diagnostic colonoscopy were invited to participate. Patients were evaluated with a high-definition colonoscopy and scored using the Diverticular Inflammation and Complication Assessment (DICA) score. The peri-diverticular and colonic mucosa were evaluated via pCLE for crypt fusion and distortion, bright epithelium, and dilated-prominent branching vessels. Complicated diverticular disease will be evaluated in a 24-month follow-up. Descriptive analysis was performed on R v3.6.0.
Results: We included sixty-three patients for analysis. The median age was 64 years, 50,8% were female. 47/63 (74.6%) of patients have at least one peridiverticular inflammation criteria on pCLE in comparison 16/63 (25.9%) in whom no inflammation was detected. The most common presenting symptom was abdominal pain in 73% of the patients. Overall, 53/63 (84.1%) of patients had a DICA I score, whereas 15.9% of patients had a DICA II score. Table 1 summarizes the baseline characteristics of the patients who exhibited peri-diverticular and colonic mucosal inflammation during pCLE evaluation. Peri-diverticular pCLE inflammation predicts a complicated diverticular disease based on a DICA score of II, with a sensitivity >80% in the ascending, transverse, descending, and sigmoid colon; and a 100% negative predictive value (NPV) in all colonic segments. In terms of colonic mucosal inflammation, the pCLE inflammation criteria have an NPV >80% in all colonic segments. 56/63 of patients exhibited colonic mucosal inflammation based on pCLE criteria, demonstrating a significant increase in the detection of inflammatory findings in patients with diverticular disease (Table 2). Patients will be follow-up up to twelve and twenty-four months for the occurrence of complicated diverticular disease to evaluate the role of these inflammatory findings.