A Systematic Review of Pericolic Extraluminal Air in Left-Sided Acute Colonic Diverticulitis

Background: Although approximately 15% of all patients with acute colonic diverticulitis have pericolic extraluminal air found on computed tomography (CT), studies on the natural course and treatment of these patients are scarce. It is not clear whether these patients behave as mild uncomplicated diverticulitis or as severe diverticulitis needing more aggressive treatment. Consequently, there is no consensus about the treatment, guidelines do not discuss this group of patients, and physicians treat these patients based on their own experiences and opinion. An evidence-based approach is needed to prevent overtreatment or undertreatment in patients with pericolic extraluminal air. Methods: PubMed and EMBASE databases were searched for all studies reporting clinical outcomes of the initial diverticulitis episode of CT-proven left-sided colonic diverticulitis. Primary outcome measures were the need for emergency surgery and percutaneous abscess drainage. Results: A total of eight studies with 251 patients with pericolic extraluminal air were included. Rates of emergency surgery in isolated patients with pericolic extraluminal air were reported in six studies, yielding a pooled rate of 6% (95% confidence interval [CI] 3%-12%). In three studies reporting a combined total of only 56 patients, no patient underwent percutaneous abscess drainage. The long-term (6 mo) need for surgery was 38% in one study, although reasons for surgery were lacking. Conclusion: An initial 94% success rate of non-operative treatment in left-sided colonic diverticulitis patients with pericolic extraluminal air seems to justify a conservative approach including antibiotic agents. Low-quality evidence indicates the need for surgery in up to 38% in the medium-long term

Image Fusion During Standard and Complex Endovascular Aortic Repair, to Fuse or Not to Fuse?: A Meta-analysis and Additional Data From a Single-Center Retrospective Cohort

Purpose: To determine if image fusion will reduce contrast volume, radiation dose, and fluoroscopy and procedure times in standard and complex (fenestrated/branched) endovascular aneurysm repair (EVAR). Materials and Methods: A search of the PubMed, Embase, and Cochrane databases was performed in December 2019 to identify articles describing results of standard and complex EVAR procedures using image fusion compared with a control group. Study selection, data extraction, and assessment of the methodological quality of the included publications were performed by 2 reviewers working independently. Primary outcomes of the pooled analysis were contrast volume, fluoroscopy time, radiation dose, and procedure time. Eleven articles were identified comprising 1547 patients. Data on 140 patients satisfying the study inclusion criteria were added from the authors’ center. Mean differences (MDs) are presented with the 95% confidence interval (CI). Results: For standard EVAR, contrast volume and procedure time showed a significant reduction with an MD of −29 mL (95% CI −40.5 to −18.5, p<0.001) and −11 minutes (95% CI −21.0 to −1.8, p<0.01), respectively. For complex EVAR, significant reductions in favor of image fusion were found for contrast volume (MD −79 mL, 95% CI −105.7 to −52.4, p<0.001), fluoroscopy time (MD −14 minutes, 95% CI −24.2 to −3.5, p<0.001), and procedure time (MD −52 minutes, 95% CI −75.7 to −27.9, p<0.001). Conclusion: The results of this meta-analysis confirm that image fusion significantly reduces contrast volume, fluoroscopy time, and procedure time in complex EVAR but only contrast volume and procedure time for standard EVAR. Though a reduction was suggested, the radiation dose was not significantly affected by the use of fusion imaging in either standard or complex EVAR