Controversies in Pouch Surveillance for Patients with Inflammatory Bowel Disease

Derikx, Lauranne; Nissen, Loes H C; Oldenburg, Bas; Hoentjen, Frank

doi:10.1093/ecco-jcc/jjw035

Cited by 16 publications

(7 citation statements)

References 21 publications

(37 reference statements)

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“…The problem of cuff dysplasia relates to retention of islets of rectal mucosa, which inevitably occurs with a stapled anastomosis. Cuff dysplasia is a rare event though[165,166], and any retained rectal mucosa usually causes more problems with cuffitis than dysplasia. It should also be noted that patients with mucosectomy and hand-sewn IPAA are not “immune” to dysplasia or cuffitis, because islands of the rectal mucosa can regrow or may be inadvertently preserved due to incomplete mucosectomy; indeed, in one series, residual rectal mucosa was identified in 20% of patients who underwent hand-sewn IPAA with mucosectomy[167].…”

Section: Complicationsmentioning

confidence: 99%

“…However, there is limited evidence for the ideal frequency of endoscopic surveillance. The British Society of Gastroenterology surveillance guidelines distinguish low risk (no high risk factors) and high risk (PSC, previous colorectal neoplasia, atrophic mucosa) groups following colectomy, and recommend surveillance intervals of 5 years and 1 year, respectively[171], but there is wide variation to this in daily practice[165].…”

Section: Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

Ileal-anal pouches: A review of its history, indications, and complications

Ng¹,

Gonsalves²,

Sagar³

2019

WJG

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The ileal pouch anal anastomosis (IPAA) has revolutionised the surgical management of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). Despite refinement in surgical technique(s) and patient selection, IPAA can be associated with significant morbidity. As the IPAA celebrated its 40 th anniversary in 2018, this review provides a timely outline of its history, indications, and complications. IPAA has undergone significant modification since 1978. For both UC and FAP, IPAA surgery aims to definitively cure disease and prevent malignant degeneration, while providing adequate continence and avoiding a permanent stoma. The majority of patients experience long-term success, but “early” and “late” complications are recognised. Pelvic sepsis is a common early complication with far-reaching consequences of long-term pouch dysfunction, but prompt intervention (either radiological or surgical) reduces the risk of pouch failure. Even in the absence of sepsis, pouch dysfunction is a long-term complication that may have a myriad of causes. Pouchitis is a common cause that remains incompletely understood and difficult to manage at times. 10% of patients succumb to the diagnosis of pouch failure, which is traditionally associated with the need for pouch excision. This review provides a timely outline of the history, indications, and complications associated with IPAA. Patient selection remains key, and contraindications exist for this surgery. A structured management plan is vital to the successful management of complications following pouch surgery.

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Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Ileal-anal pouches: A review of its history, indications, and complications

Ng¹,

Gonsalves²,

Sagar³

2019

WJG

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“…Indeed, the risk of colorectal cancer arising from the rectal remnant or ATZ is lower after IPAA than the lifetime risk of cancer in the general population [ 1 ]. However, endoscopic follow-up and surveillance after IPAA probably need to be further elucidated [ 13 , 21 ] because SCC may occur at some point even in patients with no known risk factor [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Squamous Cell Carcinoma of the Anal Transitional Zone after Ileal Pouch Surgery for Ulcerative Colitis: Systematic Review and Treatment Perspectives

et al. 2017

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Background: Few cases of pouch-related cancers have been reported in ulcerative colitis (UC), and squamous cell carcinoma (SCC) is very rare. Method: A systematic review of the literature was performed to identify all unequivocal cases of pouch-related SCC in UC patients. Results: Eight cases of SCC developing after ileal pouch-anal anastomosis (IPAA) have been observed since 1978. Two arose from the pouch mucosa and 6 from below. The pooled cumulative incidence of SCC is below 0.06% after IPAA. Many patients had neoplasia on the preoperative specimen, but squamous metaplasia of the pouch or anorectal mucosa may have an important role in SCC. These patients are rarely offered chemoradiation therapy and the outcome is poor. Selected patients with SCC located close to the pouch outlet can be treated with chemoradiation prior to consideration of surgery and salvage their pouch. A chemoradiation regimen is suggested to avoid pouch excision in these patients. Conclusions: SCC is rare after pouch surgery but associated with extremely poor survival. Very low SCC can be managed with chemoradiation treatment, preserving the pouch and avoiding surgery, even in older patients. The role of pouch metaplasia, surveillance frequency, and treatment modalities after IPAA need further studying.

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“…Only low-level evidence studies have been conducted as part of the endoscopic monitoring programme given the low prevalence of such complications. Hence, pouch monitoring remains controversial [165]. However, international guidelines based on risk stratification are available.…”

Section: Endoscopic Monitoringmentioning

confidence: 99%

Incidence and Risk Factors of Cancer in the Anal Transitional Zone and Ileal Pouch following Surgery for Ulcerative Colitis and Familial Adenomatous Polyposis

Cosquer

Buscail

Gilletta

et al. 2022

Cancers

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Proctocolectomy with ileal pouch-anal anastomosis is the intervention of choice for ulcerative colitis and familial adenomatous polyposis requiring surgery. One of the long-term complications is pouch cancer, having a poor prognosis. The risk of high-grade dysplasia and cancer in the anal transitional zone and ileal pouch after 20 years is estimated to be 2 to 4.5% and 3 to 10% in ulcerative colitis and familial polyposis, respectively. The risk factors for ulcerative colitis are the presence of pre-operative dysplasia or cancer, disease duration > 10 years and severe villous atrophy. For familial polyposis, the risk factors are the number of pre-operative polyps > 1000, surgery with stapled anastomosis and the duration of follow-up. In the case of ulcerative colitis, a pouchoscopy should be performed annually if one of the following is present: dysplasia and cancer at surgery, primary sclerosing cholangitis, villous atrophy and active pouchitis (every 5 years without any of these factors). In the case of familial polyposis, endoscopy is recommended every year including chromoendoscopy. Even if anal transitional zone and ileal pouch cancers seldom occur following proctectomy for ulcerative colitis and familial adenomatous polyposis, the high mortality rate associated with this complication warrants endoscopic monitoring.

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Controversies in Pouch Surveillance for Patients with Inflammatory Bowel Disease

Cited by 16 publications

References 21 publications

Ileal-anal pouches: A review of its history, indications, and complications

Ileal-anal pouches: A review of its history, indications, and complications

Squamous Cell Carcinoma of the Anal Transitional Zone after Ileal Pouch Surgery for Ulcerative Colitis: Systematic Review and Treatment Perspectives

Incidence and Risk Factors of Cancer in the Anal Transitional Zone and Ileal Pouch following Surgery for Ulcerative Colitis and Familial Adenomatous Polyposis

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