Current Practices in Ileal Pouch Surveillance for Patients With Ulcerative Colitis: A Multinational, Retrospective Cohort Study

Samaan, Mark A; Forsyth, Katrina; Segal, Jonathan; Jong, Djuna De; Vleugels, Jasper L A; Elkady, Soad; Kabir, Misha; Campbell, Stuart; Kok, Klaartje; Armstrong, David G.; Penez, L; Arenaza, Aitor P; Seward, Edward; Vega, Roser; Mehta, Shameer; Rahman, Farooq; McCartney, Sara; Bloom, Stuart; Patel, Kamal; Pollok, Richard; Westcott, E; Darakhshan, Amir; Williams, Andrew B.; Koumoutsos, Ioannis; Ray, Shuvra; Mawdsley, Joel; Anderson, Simon; Sanderson, Jeremy; Dekker, Evelien; D’Haens, Geert R.; Hart, Ailsa; Irving, Peter M

doi:10.1093/ecco-jcc/jjy225

Cited by 28 publications

(16 citation statements)

References 28 publications

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“…The European Crohn's and Colitis Organization (ECCO) and American Society for Gastrointestinal Endoscopy (ASGE) are the only professional societies that recommend annual pouchoscopy in patients with such risk factors as PSC, dysplasia or colorectal cancer before or at the time of colectomy, and/or pouch mucosa with persistent atrophy or severe inflammation . No specific pouch surveillance protocol is recommended for the majority of pouch patients who are asymptomatic and without risk factors, and studies from the United States and Europe indicate significant heterogeneity in practice patterns and pouchoscopy surveillance intervals …”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16] No specific pouch surveillance protocol is recommended for the majority of pouch patients who are asymptomatic and without risk factors, and studies from the United States and Europe indicate significant heterogeneity in practice patterns and pouchoscopy surveillance intervals. 17,18 Much has been published about the importance of endoscopic healing in UC and CD patients on long-term clinical outcomes; however, to our knowledge, there are no data on the predictive value of endoscopic activity on pouch outcomes or applicable "treat to target" recommendations. In our study, the association between mucosal breaks and acute pouchitis persisted after controlling for antibiotic use.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic activity in asymptomatic patients with an ileal pouch is associated with an increased risk of pouchitis

Kayal

Plietz

Radcliffe

et al. 2019

Aliment Pharmacol Ther

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Summary Background The significance of endoscopic activity in asymptomatic ulcerative colitis (UC) patients with an ileal pouch is unknown. Aim To investigate the association of endoscopic pouch activity in asymptomatic patients with the subsequent development of pouchitis. Methods We analyzed a retrospective cohort of patients with UC or IBD‐unspecified who underwent a total proctocolectomy with ileal pouch anal anastomosis (IPAA). Asymptomatic patients with a Pouchitis Disease Activity Index (PDAI) symptom sub‐score of zero who underwent an index surveillance pouchoscopy were included. Endoscopic pouch body activity was graded as 0: normal, 1: mucosal inflammation, or 2: mucosal breaks (ulcers and/or erosions). The primary outcome was primary acute idiopathic pouchitis defined as PDAI score ≥ 7 with symptoms lasting less than four weeks and responsive to standard antibiotics, not otherwise meeting criteria for secondary pouchitis. The secondary outcome was chronic idiopathic pouchitis defined as PDAI score ≥ 7 with symptoms lasting greater than four weeks despite standard antibiotics. Predictors of pouchitis were analyzed using Kaplan‐Meier and Cox regression methods with hazard ratios (HR) and 95% confidence intervals (CI) reported. Results 143 asymptomatic pouch patients were included. Index endoscopic pouch body activity was 0 in 86 (60.1%) patients, 1 in 26 (18.2%) and 2 in 31 (21.7%). The median length of follow‐up after index surveillance pouchoscopy was 3.03 [IQR 1.24‐4.60] years. Primary acute idiopathic pouchitis occurred in 44 (31%) patients and chronic idiopathic pouchitis in 12 (8.4%). Grade 2 endoscopic pouch activity was associated with the development of acute pouchitis (HR 2.39, 95% CI 1.23‐4.67), although not chronic pouchitis (HR 1.76, 95% CI 0.53‐5.87). Histologic inflammation in endoscopically normal pouch mucosa was not associated with acute or chronic pouchitis. Conclusions Mucosal breaks are present in nearly a quarter of asymptomatic patients with IPAA and are associated with an increased risk of acute pouchitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endoscopic activity in asymptomatic patients with an ileal pouch is associated with an increased risk of pouchitis

Kayal

Plietz

Radcliffe

et al. 2019

Aliment Pharmacol Ther

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“…Despite those recommendations, an American survey reported by Gu et al found heterogeneous practices concerning the endoscopy interval [170]. A European retrospective cohort study found similar results with one-third of the cohort who had never undergone pouchoscopy during follow-up (median duration of 10.5 years) [171].…”

Section: Endoscopic Monitoringmentioning

confidence: 90%

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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“…They do not recommend a specific follow-up strategy in asymptomatic patients. Samaan et al in their multi-national retrospective cohort study identified two cases of adenocarcinoma in the rectal cuff of low-risk patients [ 48 ]. They concluded that it may be beneficial to perform pouchoscopy 1 year post-operation, with biopsies to further risk stratify patients based on clinical factors alone.…”

Section: Surveillance Strategiesmentioning

confidence: 99%

Colorectal Dysplasia and Cancer Surveillance in Ulcerative Colitis

et al. 2021

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Ulcerative colitis (UC) is a risk factor for the development of inflammation-associated dysplasia or colitis-associated neoplasia (CAN). This transformation results from chronic inflammation, which induces changes in epithelial proliferation, survival, and migration via the induction of chemokines and cytokines. There are notable differences in genetic mutation profiles between CAN in UC patients and sporadic colorectal cancer in the general population. Colonoscopy is the cornerstone for surveillance and management of dysplasia in these patients. There are several modalities to augment the quality of endoscopy for the better detection of dysplastic or neoplastic lesions, including the use of high-definition white-light exam and image-enhanced colonoscopy, which are described in this review. Clinical practice guidelines regarding surveillance strategies in UC have been put forth by various GI societies, and overall, there is agreement between them except for some differences, which we highlight in this article. These guidelines recommend that endoscopically detected dysplasia, if feasible, should be resected endoscopically. Advanced newer techniques, such as endoscopic mucosal resection and endoscopic submucosal dissection, have been utilized in the treatment of CAN. Surgery has traditionally been the mainstay of treating such advanced lesions, and in cases where endoscopic resection is not feasible, a proctocolectomy, followed by ileal pouch-anal anastomosis, is generally recommended. In this review we summarize the approach to surveillance for cancer and dysplasia in UC. We also highlight management strategies if dysplasia is detected.

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Current Practices in Ileal Pouch Surveillance for Patients With Ulcerative Colitis: A Multinational, Retrospective Cohort Study

Cited by 28 publications

References 28 publications

Endoscopic activity in asymptomatic patients with an ileal pouch is associated with an increased risk of pouchitis

Endoscopic activity in asymptomatic patients with an ileal pouch is associated with an increased risk of pouchitis

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

Colorectal Dysplasia and Cancer Surveillance in Ulcerative Colitis

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