Confocal Laser Endomicroscopy In The Colonic Mucosa Of Patients With Diverticular Disease: Interim Results

Aims 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.

Tab. 1

	Present on white light colonoscopy and pCLE	Absent at white light colonoscopy but present on pCLE	p-value
Edema or hyperemia, n (%)	4 (7.1)	52 (92.9)	< 0.001
Erosions, n (%)	1 (1.8)	55 (98.2)	< 0.001
Segmental colitis associated with diverticulosis	5 (8.9)	51 (91.1)	< 0.001

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 %) patients without inflammation. The most common presenting symptom was abdominal pain in 73 % of patients. Overall, 53/63 (84.1 %) of patients had a DICA I score, whereas 15.9 % of patients had a DICA II score. 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 1). Patients will be follow-up up to twenty-four months for the complicated diverticular occurrence and evaluate the role of these inflammatory findings (NCT04173182).

Conclusions Confocal laser endomicroscopy is a promising marker to detect inflammation in diverticular disease, even in those patients without inflammation on colonoscopy. Peri-diverticular inflammation may play role in predicting a complicated disease that should be evaluated in the follow-up study.

Citation: Robles-Medranda C, Oleas R, Puga-Tejada M etal. eP305 CONFOCAL LASER ENDOMICROSCOPY IN THE COLONIC MUCOSA OF PATIENTS WITH DIVERTICULAR DISEASE: INTERIM RESULTS. Endoscopy 2021; 53: S198.

Publication History

Article published online:
19 March 2021