Risk of dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis

Abstract

Based on these data a surveillance programme should begin at 10 years from the onset of disease. Patients with dysplasia or carcinoma in the original specimen, those with type C ileal mucosal changes and patients with sclerosing cholangitis should be selected for surveillance. This will involve multiple biopsies of the ileal reservoir and the anorectal mucosa below the ileo-anal anastomosis.

Pouchitis

“…Although PSC is a risk factor for pouchitis [3,44,45] , liver transplantation with post-transplant use of immunosuppressive agents does not appear to have adverse effects on the course of pouchitis [81,82] . In addition, chronic inflammation of the pouch and cuff may pose an increased risk of developing dysplasia or cancer [83,84] . In summary, pouchitis is the most common long-term adverse sequela of IPAA after restorative proctocolectomy.…”

Surveillance for Dysplasia in Patients with Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Interim Analysis

“…Nonetheless, some authors have reported malignancy as a complication of severe chronic pouchitis in the absence of backwash ileitis or history of colon cancer and as early as 2 years after ileostomy closure [4,15]. In a recent literature review, Das IPAA ileal pouch-anal anastomosis since 1992.…”

“…Given that, Das et al [4] suggested a new plan of surveillance to be started at 6-12 months after IPAA in order to identify type C inflammatory changes. They recommended distal and proximal biopsies in four quadrants to be repeated annually in patients with colonic dysplasia or cancer, more than 10 years with UC, primary sclerosing cholangitis, type C mucosa, and ileal pouch-rectal anastomosis.…”

Inflammatory bowel disease: the problems of dysplasia and surveillance

“…The recent review by Das et al [93] noted that there have only been 17 reported cases of cancer arising in the ileal anal pouch: seven arising from the pouch mucosa and ten from the anorectal mucosa. Twelve of the 17 patients had dysplasia or cancer in the original proctocolectomy specimens.…”