Long-Term Outcomes in Indeterminate Colitis Patients Undergoing Ileal Pouch-Anal Anastomosis: Function, Quality of Life, and Complications

Abstract

Patients undergoing IPAA for IC have a higher risk of post-operative fistulae and development of Crohn's disease, but comparable morbidity, functional outcomes, quality of life scores and pouch failure rates when compared to UC patients. Long-term data confirms that IPAA is a good surgical option in patients with IC.

Is There a Role for Ileal Pouch Anal Anastomosis in Crohn's Disease?

“…While some studies have suggested poorer pouch outcomes among patients with IC in comparison to those with UC, 20-24 more recent reports have indicated outcomes similar to those seen in UC. 8,[25][26][27][28][29] In particular, these studies show that IC does not appear to have a significant effect on pouch failure rates. 8,26,27,29 Similarly, many studies reveal comparable functional outcome.…”

“…8,[25][26][27][28][29] In particular, these studies show that IC does not appear to have a significant effect on pouch failure rates. 8,26,27,29 Similarly, many studies reveal comparable functional outcome. 22,24,26,27,29 Still, some argue that patients with IC may be at increased risk of developing pouch-related complications, 8,27,29 perhaps related to an increased risk of developing CD of the pouch in this population.…”

“…8,26,27,29 Similarly, many studies reveal comparable functional outcome. 22,24,26,27,29 Still, some argue that patients with IC may be at increased risk of developing pouch-related complications, 8,27,29 perhaps related to an increased risk of developing CD of the pouch in this population. 23,24,27 Intuitively, many would agree with the assertion made by McIntyre et al that patients with IC who do not develop CD of the pouch have more similar outcomes to patients with UC.…”

“…Several studies have revealed an increased incidence of evolution to CD among patients with IC in comparison to those with UC. 23,24,27,29 However, others show no difference in rates of developing CD 26,28 (►Table 2).…”

“…The largest and perhaps most well-designed study, by Jackson et al in 2017, used case-matched analysis to show that while patients with IC undergoing IPAA develop CD at higher rates than their UC counterparts, their pouch outcomes including morbidity, function, and pouch failure rates are comparable. 29 While the evidence is somewhat conflicting with regard to whether there may be an increased incidence of CD of the pouch among patients with IC undergoing IPAA, it appears certain that patients with IC can be considered for IPAA with satisfactory outcomes that may be similar to those in UC.…”