Predicting Diverticulitis and Surgery for Diverticulitis Based on Endoscopic and Clinical Features: DICA and CODA Scoring
Douglas K. Rex, MD, MASGE, reviewing Tursi A, et al. Gut 2021 Oct 26.
The Diverticular Inflammation and Complication Assessment (DICA) endoscopic scale is a scoring system that predicts diverticulitis and related surgery. Briefly, this scale takes into account (1) diverticular extension into the proximal colon; (2) the number of diverticula (less than or more than 15) in each district (proximal vs distal); (3) the presence of inflammation, such as edema/hyperemia, erosions, and segmental colitis associated with diverticula; and (4) complications, such as rigidity, stenosis, pus, and bleeding. Depending on the total points, DICA is classified as a score of 1, 2, or 3, with a score of 3 having the highest risk of diverticulitis and surgery within the next 3 years.
A new study from 43 centers in Europe and South America prospectively followed 2198 patients. The 3-year cumulative probabilities of diverticulitis and surgery were 3.3% and 0.15% in DICA 1, 11.6% and 3% in DICA 2, and 22% and 11% in DICA 3, respectively.
Developed for this study, the Combined Overview on Diverticular Assessment (CODA) scale incorporates the DICA endoscopic score but also includes abdominal pain as a continuous variable and age as a dichotomous variable (younger than 65 years and age 65 or older). The CODA score also is grouped into 3 categories: A, B, and C. The 3-year probabilities of diverticulitis and surgery were ≤4% and ≤0.7% in CODA-A, <10% and <2.5% in CODA-B, and >10% and >2.5% in CODA-C, respectively. CODA had optimal performance in predicting the risk of surgery.
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COMMENTThe details of DICA and CODA scoring are available on the internet. These scores are potentially very useful in advising patients about their risk of surgery after an endoscopic diagnosis of diverticulosis.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Tursi A, Brandimarte G, Di Mario F, et al. Prognostic performance of the ‘DICA’ endoscopic classification and the ‘CODA’ score in predicting clinical outcomes of diverticular disease: an international, multicentre, prospective cohort study. Gut 2021 Oct 26. (Epub ahead of print) (https://doi.org/10.1136/gutjnl-2021-325574)