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Multicenter Study
. 2022 Jul;71(7):1350-1358.
doi: 10.1136/gutjnl-2021-325574. Epub 2021 Oct 26.

Prognostic performance of the 'DICA' endoscopic classification and the 'CODA' score in predicting clinical outcomes of diverticular disease: an international, multicentre, prospective cohort study

Antonio Tursi  1   2 , Giovanni Brandimarte  3 , Francesco Di Mario  4 , Walter Elisei  5 , Marcello Picchio  6 , Leonardo Allegretta  7 , Maria Laura Annunziata  8 , Mauro Bafutto  9 , Gabrio Bassotti  10 , Maria Antonietta Bianco  11 , Raffaele Colucci  12 , Rita Conigliaro  13 , Dan Dumitrascu  14 , Ricardo Escalante  15 , Luciano Ferrini  16 , Giacomo Forti  17 , Marilisa Franceschi  18 , Maria Giovanna Graziani  19 , Frank Lammert  20 , Giovanni Latella  21 , Giovanni Maconi  22 , Gerardo Nardone  23 , Lucia Camara de Castro Oliveira  24 , Enio Chaves Oliveira  25 , Alfredo Papa  26 , Savvas Papagrigoriadis  27 , Anna Pietrzak  28 , Stefano Pontone  29 , Tomas Poskus  30 , Giuseppe Pranzo  31 , Matthias Christian Reichert  20 , Stefano Rodinò  32 , Jaroslaw Regula  33   34 , Giuseppe Scaccianoce  35 , Franco Scaldaferri  36 , Roberto Vassallo  37 , Costantino Zampaletta  38 , Angelo Zullo  39 , Daniele Piovani  40   41 , Stefanos Bonovas  40   41 , Silvio Danese  42 ; DICA International Group
Collaborators, Affiliations
Multicenter Study

Prognostic performance of the 'DICA' endoscopic classification and the 'CODA' score in predicting clinical outcomes of diverticular disease: an international, multicentre, prospective cohort study

Antonio Tursi et al. Gut. 2022 Jul.

Abstract

Objective: To investigate the predictive value of the Diverticular Inflammation and Complication Assessment (DICA) classification and to develop and validate a combined endoscopic-clinical score predicting clinical outcomes of diverticulosis, named Combined Overview on Diverticular Assessment (CODA).

Design: A multicentre, prospective, international cohort study.

Setting: 43 gastroenterology and endoscopy centres located in Europe and South America.

Participants: 2215 patients (2198 completing the study) at the first diagnosis of diverticulosis/diverticular disease were enrolled. Patients were scored according to DICA classifications.

Interventions: A 3-year follow-up was performed.

Main outcome measures: To predict the acute diverticulitis and the surgery according to DICA classification. Survival methods for censored observation were used to develop and validate a novel combined endoscopic-clinical score for predicting diverticulitis and surgery (CODA score).

Results: The 3-year cumulative probability of diverticulitis and surgery was of 3.3% (95% CI 2.5% to 4.5%) in DICA 1, 11.6% (95% CI 9.2% to 14.5%) in DICA 2 and 22.0% (95% CI 17.2% to 28.0%) in DICA 3 (p<0.001), and 0.15% (95% CI 0.04% to 0.59%) in DICA 1, 3.0% (95% CI 1.9% to 4.7%) in DICA 2 and 11.0% (95% CI 7.5% to 16.0%) in DICA 3 (p<0.001), respectively. The 3-year cumulative probability of diverticulitis and surgery was ≤4%, and ≤0.7% in CODA A; <10% and <2.5% in CODA B; >10% and >2.5% in CODA C, respectively. The CODA score showed optimal discrimination capacity in predicting the risk of surgery in the development (c-statistic: 0.829; 95% CI 0.811 to 0.846) and validation cohort (c-statistic: 0.943; 95% CI 0.905 to 0.981).

Conclusions: DICA classification has a significant role in predicting the risk of diverticulitis and surgery in patients with diverticulosis, which is significantly enhanced by the CODA score.

Trial registration number: NCT02758860.

Keywords: diverticular disease; endoscopy.

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Conflict of interest statement

Competing interests: SD served as speaker, consultant and/or advisory board member for AbbVie, Allergan, Alfa Wassermann, Biogen, Boehringer Ingelheim, Celgene, Celltrion, Ferring, Gilead, Hospira, Johnson and Johnson, Merck, MSD, Mundipharma, Pfizer, Sandoz, Takeda, Tigenix, UCB Pharma, Vifor. GM served as speaker and/or advisory board fees for AlfaSigma, Arena, Janssen, Gilead, Roche. GN received funding for target projects from Apharm and Sofar. APserved as lecturer for AlfaSigma and Polpharma. JR served as lecturer for AlfaSigma, Takeda, Ipsen and Servier. FS served as lecturer for Sanofi.

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