European evidence based consensus on surgery for ulcerative colitis

Øresland, Tom; Bemelman, Willem A.; Sampietro, Gianluca; Spinelli, Antonino; Windsor, Alastair; Ferrante, Marc; Marteau, Philippe; Zmora, Oded; Kotze, Paulo Gustavo; Espín‐Basany, Eloy; Tiret, Emmanuel; Sica, Giuseppe; Panís, Yves; Færden, Arne E.; Biancone, Livia; Angriman, Imerio; Šerclová, Zuzana; Overstraeten, Anthony de Buck van; Gionchetti, Paolo; Stassen, Laurents P. S.; Warusavitarne, Janindra; Adamina, Michel; Dignaß, Axel; Eliakim, Rami; Magro, Fernando; D’Hoore, André

doi:10.1016/j.crohns.2014.08.012

Cited by 300 publications

(250 citation statements)

References 272 publications

(381 reference statements)

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“…The principal advantages of a conservative management of toxic megacolon in pregnant women is to let the baby reach an appropriate gestational age to survive and, secondly, prevent the mother from having to undergo an emergency colectomy during gravidic sepsis. Although current guidelines describe toxic megacolon as an indication of emergency surgery [18] , endoscopic decompression together with medical treatment and intensive monitoring should be a potentially successful management of severe UC complicated by toxic megacolon during pregnancy. Conversely, the presence of signs of acute abdomen, including perforation, abscess, ischemia, thrombosis (which were not present in our patient), and/or the lack of early response to conservative therapy, are indicators for surgery.…”

Section: B Amentioning

confidence: 99%

“…In our case, the colonoscopy was performed not only for the diagnosis of UC complicated by toxic megacolon, but also to perform a colonoscopic decompression. Abdominal surgery, particularly when performed in the third trimester, is reported to increase the incidence of preterm labor and, consequently, implies a higher risk of adverse perinatal outcome [18] . According to guidelines, the indications for emergency surgery are the same for pregnant and non-pregnant women, including failed medical treatment [19] and complications such as toxic megacolon [2] .…”

Section: B Amentioning

confidence: 99%

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Fulminant ulcerative colitis in a healthy pregnant woman

Orabona

Valcamonico

Salemme

et al. 2015

WJG

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This case report concerns a 25-year-old patient with 6-7 bloody stools/d, abdominal pain, tachycardia, and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic megacolon and gravidic sepsis was diagnosed by clinical evaluation, colonoscopy, and rectal biopsy that were performed safely without risk for the mother or baby. The patient underwent a cesarean section at 28+6 wk gestation. The baby was transferred to the neonatal intensive care unit of our hospital and survived without complications. Fulminant colitis was managed conservatively by combined colonoscopic decompression and medical treatment. Although current European guidelines describe toxic megacolon as an indication for emergency surgery for both pregnant and non-pregnant women, thanks to careful monitoring, endoscopic decompression, and intensive medical therapy with nutritional support, we prevented the woman from having to undergo emergency pancolectomy. Our report seems to suggest that conservative management may be a helpful tool in preventing pancolectomy if the patient's condition improves quickly. Otherwise, surgery is mandatory.

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Section: B Amentioning

confidence: 99%

Section: B Amentioning

confidence: 99%

Fulminant ulcerative colitis in a healthy pregnant woman

Orabona

Valcamonico

Salemme

et al. 2015

WJG

View full text Add to dashboard Cite

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“…This outlines the importance of careful review of all histopathology results, including the colectomy specimen, by an experienced pathologist prior to proceeding with definitive pouch surgery. This is the standard recommendation for surgery for UC 19. The two cases who were missed diagnoses of CD contributed to our results of the younger age effect as both cases were under 25 at the time of IBD diagnosis, and under 30 at the time of surgery.…”

Section: Discussionmentioning

confidence: 80%

Patchy colitis, and young age at diagnosis and at the time of surgery predict subsequent development of Crohn's disease after ileal pouch‐anal anastomosis surgery for ulcerative colitis

et al. 2018

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Background and AimA proportion of patients having total proctocolectomy and ileal pouch‐anal anastomosis (IPAA) for ulcerative colitis (UC) are later diagnosed with Crohn's disease (CD). The aim of this study was to identify preoperative and perioperative predictors for the subsequent development of CD in patients who had IPAA for presumed UC.MethodsA retrospective case–control study of patients undergoing IPAA surgery for presumed UC was undertaken. Cases were patients who had a revised diagnosis of CD after surgery. Preoperative and perioperative variables were examined and analyzed.ResultsFifteen cases were compared with 39 controls. Patients aged ≤25 years at initial UC diagnosis were more likely to develop CD compared to those aged >25 years (odds ratio, OR [95% confidence interval, CI]: 7.1 [1.6–31.3]; P = 0.01). Patients aged ≤30 years at the time of colectomy had an increased risk of subsequent development of CD compared to those aged >30 years (OR [95% CI]: 4.5 [1.3–16.0]; P = 0.02). Cases were more likely to have patchy colitis on their colectomy specimen (OR [95% CI]: 6.7 [1.1–41.8]; P = 0.04). There was no significant difference between groups regarding transmural inflammation, ileitis, or fissuring ulcers on colectomy specimens, or preoperative C‐reactive protein (CRP), albumin, family history, and smoking status.ConclusionPredictors of the development of CD in the pouch include young age at diagnosis and at the time of surgery, and patchy colitis in the resected colon.

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“…The current guidelines of the European Crohn's and Colitis Organisation do not recommend any specific follow-up of the pouch in patients with no risk factors. 62 Few data are available for the management of pouch and anal transitional zone dysplasia. In low-grade dysplasia (LGD) arising from the residual anorectal mucosa after stapled IPAA or inadequate mucosectomy, mucosectomy with IPAA advancement 59 may be a prudent choice, but a wait-and-see approach may be appropriate.…”

Section: Neoplastic Complicationsmentioning

confidence: 99%

Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

Pellino¹,

Selvaggi²

2015

ECCOJC

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Background and Aims: Failure rates of restorative proctocolectomy with ileo pouch-anal anastomosis (IPAA) range between 3.5 and 15%. Salvage surgery aims to preserve the pouch and transanal evacuation. We report our experience with salvage, review the outcomes of revisional pouch surgery, and propose a classification of pouch dysfunction. Methods: We collected data on patients undergoing pouch salvage surgery between 1987 and 2014 at our hospital. Pre-and post-salvage functional data were assessed. Function at the 3-year follow-up was compared with that of matched IPAA controls (study patients:controls, 1:3). Results: Considering only patients who underwent primary IPAA at our centre (n = 31), 5-year failure was higher after salvage compared with primary IPAA (28.8 vs 5.7% log rank test, p = 0.005). Overall, we included 39 patients, with eight additional patients who received primary IPAA elsewhere, undergoing 46 procedures. Most patients had a J-pouch (74.4%) and needed salvage for septic complications. A transperineal approach was used in 22 patients, whereas 17 underwent abdominal salvage, with 77.3 and 64.7% success rates, respectively. Minor surgery was effective but required repeated procedures. Overall failure was 28.2% at a median follow-up of 42 (1-153) months. A significant decrease in bowel frequency (p = 0.021) and rate of urgency (p = 0.009) was observed at the 3-year follow-up after salvage in 25 patients available for comparison. Functional results after major salvage procedures were poorer compared with healthy IPAA controls (p = 0.003). Conclusions: Salvage surgery is effective and safe in experienced teams, but the 5-year failure rate is higher after salvage than after successful primary pouch surgery. Sepsis brings about a higher risk of failure compared with mechanical causes of dysfunction.

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European evidence based consensus on surgery for ulcerative colitis

Cited by 300 publications

References 272 publications

Fulminant ulcerative colitis in a healthy pregnant woman

Fulminant ulcerative colitis in a healthy pregnant woman

Patchy colitis, and young age at diagnosis and at the time of surgery predict subsequent development of Crohn's disease after ileal pouch‐anal anastomosis surgery for ulcerative colitis

Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

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