Endoscopic Therapy for Pouch Leaks and Strictures: A Systematic Review

Lee, Eunah; Shen, Bo

doi:10.1097/dcr.0000000000002538

Cited by 15 publications

(7 citation statements)

References 63 publications

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“…CTE and MRE can demonstrate the number, location, degree, and length of strictures and the presence of prestenotic luminal dilation, fistulas, or abscesses. [17][18][19][20] Cross-sectional imaging such as CT, CTE, and MRE may also be used to highlight other structural disorders of the pouch, such as floppy pouch complex (FPC), pouch volvulus, 21 or megapouch (Fig. 4).…”

Section: Structural Complications Of the Pouchmentioning

confidence: 99%

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Radiographic Evaluation of Ileal Pouch Disorders: A Systematic Review

Shen,

Bruining,

YunMa

2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Radiographic imaging of abdomen and pelvis plays an important role in the diagnosis and management of ileal pouch disorders with modalities including computed tomography, magnetic resonance imaging, contrasted pouchography, and defecography. OBJECTIVES: A systematic review of the literature was performed and applications of cross-sectional imaging, pouchography, defecography, and ultrasonography are described. DATA SOURCES: PubMed, Google Scholar, and Cochrane database. STUDY SELECTION: Relevant articles on endoscopy in ileal pouches published between Jan 2003 and June 2023 in English were included based on PRISMA guidelines. INTERVENTION: Main abdominal and pelvic imaging modalities and their applications in the diagnosis of ileal pouch disorders were included. MAIN OUTCOME MEASURES: Accuracy in characterization of the ileal pouch disorders. RESULTS: Computed tomography is the test of the choice for the evaluation of acute anastomotic leaks, perforation, and abscess(es). Magnetic resonance imaging of the pelvis is suitable for the evaluation of chronic anastomotic leaks and their associated fistulas and sinus tracts, as well as for the penetrating phenotype of Crohn’s disease of the pouch. Computed tomography enterography and magnetic resonance enterography are useful in the assessment of intraluminal, intramural, and extraluminal disease processes of the pouch and prepouch ileum. Water-soluble contrast pouchography is particularly useful for the evaluation of acute or chronic anastomotic leaks and outlines the shape and configuration of the pouch. Defecography is the key modality to evaluate structural and functional pouch inlet and outlet obstructions. Ultrasonography can be performed to assess the pouch in experienced IBD centers. LIMITATIONS: This is a qualitative, not quantitative review of mainly case series and case reports. CONCLUSIONS: Abdominopelvic imaging along with clinical and endoscopic evaluation is imperative for the accurate assessment of structural, inflammatory, functional, and neoplastic disorders. See video from symposium.

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Section: Structural Complications Of the Pouchmentioning

confidence: 99%

“…CTE and MRE can demonstrate the number, location, degree, and length of strictures and the presence of prestenotic luminal dilation, fistulas, or abscesses. 17–20…”

Section: Ct and Ctementioning

confidence: 99%

Radiographic Evaluation of Ileal Pouch Disorders: A Systematic Review

Shen,

Bruining,

YunMa

2024

Diseases of the Colon &Amp; Rectum

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“…6C), whereas ischemia or CD-associated strictures in the prepouch ileum can be more prolonged and multiple. 31…”

Section: Afferent Limb/prepouch Ileummentioning

confidence: 99%

Endoscopic Evaluation of the Ileal Pouch

Shen

2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Structural and inflammatory adverse sequelae are common after restorative proctocolectomy and ileal pouch-anal anastomosis. On rare occasions, neoplasia can occur in patients with ileal pouches. Pouchoscopy plays a key role in the diagnosis, differential diagnosis, disease monitoring, assessment of treatment response, surveillance, and delivery of therapy. OBJECTIVE: A systemic review of the literature was performed and principles and techniques of pouchoscopy were described. DATA SOURCES: PubMed, Google Scholar, and Cochrane database. STUDY SELECTION: Relevant articles on endoscopy in ileal pouches published between Jan 2000 and May 2023 were including based on PRISMA guidelines. INTERVENTION: Diagnostic, surveillance, and therapeutic endoscopy in ileal pouch disorders were included. MAIN OUTCOME MEASURES: Accurate characterization of the ileal pouch at the healthy or diseased states. RESULTS: The main anatomic structures of a J or S pouch are the stoma closure site, prepouch ileum, inlet, tip of the “J,” pouch body, anastomosis, cuff, and anal transition zone. Each anatomic location can be prone to the development of structural, inflammatory, or neoplastic disorders. For example, ulcers and strictures are common at the stoma closure site, inlet, and anastomosis. Leaks are commonly detected at the tip of the “J” and anastomosis. Characterization of the anastomotic distribution of inflammation is critical for the differential diagnosis of subtypes of pouchitis and other inflammatory disorders of the pouch. Neoplastic lesions, albeit rare, mainly occur at the cuff, anal transition zone, or anastomosis. LIMITATIONS: This is a qualitative, not quantitative review of mainly case series. CONCLUSIONS: Most structural, inflammatory, and neoplastic disorders can be reliably diagnosed with a careful pouchoscopy. The endoscopist and other clinicians taking care of pouch patients should be familiar with the anatomy of the ileal pouch, and recognize common abnormalities. See video from symposium. See Video.

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“…56 Endoscopic stricturotomy involves using a transendoscopic needle knife or insulated-tip knife with or without electrocautery to incise the stricture radially or circumferentially. 55,62 There are limited studies that assess outcomes of endoscopic stricturotomy specifically for pouch strictures and none that specifically look at CLIPI. One case series reported on 85 patients who had a total of 127 pouch strictures treated with endoscopic stricturotomy with needle knife.…”

Section: Surgical Salvage Strategies In Crohn's-like Ileal Pouch Illn...mentioning

confidence: 99%

Crohn's-like Ileal Pouch Illness and Ileal Pouch Salvage Strategies

Huang,

Abeshouse,

Lee

et al. 2024

Clin Colon Rectal Surg

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De novo Crohn's disease (CD) of the pouch or Crohn's-like Ileal Pouch Illness (CLIPI) is an increasingly common occurrence in an ever-growing ileal pouch population. Although currently undetermined if a subset of classic CD or a completely new entity, it primarily affects the prepouch afferent limb, pouch, and rectal cuff. Symptoms can mimic other more common disorders, such as pouchitis, and requires a thorough workup, including pouchoscopy with biopsy and often cross-sectional imaging, for the diagnosis to be made. There is an increased risk of long-term pouch failure in this population. Treatment is typically dependent upon the disease phenotype with surgical management considered in a step-up fashion. Medical management is primarily performed with “biologics,” such as antitumor necrosis factor agents, although data are limited due to the lack of randomized controlled trials. Surgical management for CLIPI can include endoscopic, anorectal, and abdominal approaches to assist as “pouch-salvage strategies.” The performance of advanced pouch-salvage techniques in the CLIPI population requires careful patient selection and should preferably be performed at high-volume pouch centers.

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Endoscopic Therapy for Pouch Leaks and Strictures: A Systematic Review

Cited by 15 publications

References 63 publications

Radiographic Evaluation of Ileal Pouch Disorders: A Systematic Review

Radiographic Evaluation of Ileal Pouch Disorders: A Systematic Review

Endoscopic Evaluation of the Ileal Pouch

Crohn's-like Ileal Pouch Illness and Ileal Pouch Salvage Strategies

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