Mucosal Dysplasia in Ileal Pelvic Pouches After Restorative Proctocolectomy

Nilubol, Naris; Scherl, Ellen; Bub, David S.; Gorfine, Stephen R.; Marion, James F.; Harris, Michael T.; Kornbluth, Asher; Lichtiger, Simon; Rubin, Peter; George, James; Chapman, Mark L.; Harpaz, Noam; Present, Daniel H.; Bauer, Joel J.

doi:10.1007/s10350-007-0217-6

Cited by 41 publications

(22 citation statements)

References 46 publications

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“…Th e development of dysplasia or adenocarcinoma in pouches is very infrequent ( 356,357 ). Risk factors for dysplasia include long duration of UC before proctocolectomy, chronic pouchitis, PSC, and dysplasia or adenocarcinoma in the colectomy specimen ( 356,358,359 ).…”

Section: Recommendations For the Management Of Pouchitismentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

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1,140

977

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Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifi cally valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identifi ed as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specifi c problem. Guidelines are intended to be fl exible and must be distinguished from standards of care, which are infl exible and rarely violated. Given the wide range of specifi cs in any healthcare problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the fi eld, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case -control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.

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Section: Recommendations For the Management Of Pouchitismentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

Self Cite

1,140

977

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“…44,45 These numbers imply the idea that the development of adenomas is accelerated in the ileal pouch of patients with FAP, 46 although others found that mucosal dysplasia is uncommon. 47 Furthermore, the description of less than 10 pouch adenocarcinomas so far 9,10,48,49 may indicate that RPC does not eliminate the risk of malignization. So, the tradeoff of neoplasia control in FAP patients seems to be much more complex than previously thought.…”

Section: Discussionmentioning

confidence: 97%

Rectal and Pouch Recurrences After Surgical Treatment for Familial Adenomatous Polyposis

Campos

Imperiale

Seid

et al. 2009

Journal of Gastrointestinal Surgery

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(1) Within the present series, FAP patients presented a high incidence of associated CRC and diagnosis was generally established after the third decade of life; (2) operative complications occurred in about one third of the patients, being more frequent after the confection of an ileal reservoir; (3) rectal cancer after IRA was detected in 16.6% of patients and it was associated with greater age and previous colonic carcinoma; (4) both continuous and long-term surveillance of the rectal stump and ileal pouch are necessary during follow-up.

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“…In a cross-sectional study of 128 IPAA patients with underlying IBD, one patient with IND had no dysplasia on subsequent surveillance biopsy. 26 In a separate study of 113 cases, one patient had IND on two consecutive endoscopy biopsies and no dysplasia or IND was found in a subsequent endoscopic biopsy. 27 On the other hand, IND may "progress".…”

Section: Discussionmentioning

confidence: 97%

Clinical Significance of Indefinite for Dysplasia on Pouch Biopsy in Patients with Underlying Inflammatory Bowel Disease

Liu

Patil

et al. 2012

Journal of Gastrointestinal Surgery

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Mucosal Dysplasia in Ileal Pelvic Pouches After Restorative Proctocolectomy

Abstract: Clinical and microscopic evidence of ileal-pouch inflammation is common. Ileal-pouch mucosal dysplasia is uncommon, occurring in only 1 of 138 patients. Villous atrophy and colonic metaplasia were not observed in this series. Routine pouch surveillance with biopsies may not be warranted.

Cited by 41 publications

References 46 publications

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Rectal and Pouch Recurrences After Surgical Treatment for Familial Adenomatous Polyposis

Clinical Significance of Indefinite for Dysplasia on Pouch Biopsy in Patients with Underlying Inflammatory Bowel Disease

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