Risk of dysplasia in the columnar cuff after stapled restorative proctocolectomy

Coull, D. B.; Lee, F. D.; Henderson, Annette; Anderson, John H.; McKee, Ruth F.; Finlay, I. G.

doi:10.1002/bjs.4007

Cited by 63 publications

(46 citation statements)

References 24 publications

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“…Their mean age was 45 years . The mean length of hospital stay was 11 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) days. Twenty two (63%) were treated due to FAP, 12 (34%) for colon tumor or polyp with concomitant rectum cancer and 1 (3%) for severe dysplasia in ulcerative colitis.…”

Section: Resultsmentioning

confidence: 99%

“…Once it was identified that the anal transition site immediately above the dentate line contributed to incontinence, the requirement for mucosectomy started to be questioned (10). However, a site with cancer is left behind if a rectum wall of more than 1.5-2 cm remains in place (11). In our clinic, our cases routinely undergo mucosectomy.…”

Section: Discussionmentioning

confidence: 99%

“…It was believed that protective ileostomy was absolutely required following an IPAA procedure in the initial years of the restorative protocolectomy technique (11,12). Even though protective ileostomy does not prevent potential leakages from distal anastomosis, it ensures that the patient experiences this event more lightly in clinical terms.…”

Section: Discussionmentioning

confidence: 99%

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Review of our ileal pouch experience in the light of literature

Çakır

Doğan

Küçükkartallar

et al. 2015

UCD

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Objective: Retrospective proctocolectomy is a distinguished, sphincter saving treatment used for the treatment of ulcerative colitis and FAP disease. We aimed to evaluate ileal pouch interventions performed at our clinic and their results in the light of literature. Material and Methods:Medical records of 35 restorative proctocolectomy and J pouch ileo-anal anastomosis surgeries performed at Necmettin Erbakan University, Meram School of Medicine between the years 2006-2013 were retrospectively examined. The patients were assessed according to their age, gender, length of hospital stay, diagnosis, follow-up duration and pouch-related complications. All patients were contacted by phone and they were scheduled for controls at the outpatient clinic.Results: Nineteen patients were male (54%) and 16 were female (46%). Their mean age was 45 years (21-74). The mean length of hospital stay was 11 (5-20) days. Twenty two (63%) patients were operated on due to FAP, 12 (34%) due to synchronous rectum cancer and colon tumor or polyp, and one (3%) due to ulcerative colitis. All patients received J pouch and protective ileostomy. After the closure of ileostomy, two cases were identified to have J pouch fistulas. The patients were followed up for 6 months to 7 years. They were contacted by phone and they were questioned about their active complaints, number of defecations, urinary and sexual dysfunctions. It was identified that they had 5 (3-8) defecations per day on average and that 4 (11%) cases had one nocturnal defecation. No pouchitis was identified in the follow-up endoscopic examinations. Conclusion:Restorative proctocolectomy and ileo-anal anastomosis technique is a surgical procedure that can be performed with low rates of morbidity and mortality, including the elderly.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Review of our ileal pouch experience in the light of literature

Çakır

Doğan

Küçükkartallar

et al. 2015

UCD

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“…Also, any residual rectal mucosa is subject to persistent inflammation caused by ulcerative colitis (cuffitis) as well as the risk of colitisassociated dysplasia and carcinoma, particularly in patients with dysplasia or carcinoma in the resected colon. [6][7][8][9] A rectal mucosectomy may alleviate this somewhat, but in our experience, any colonic/rectal mucosa left behind by such a procedure (or when a mucosectomy is not performed) can interdigitate with the now-adjacent ileal mucosa as the anastomosis matures to create a histological 'hybrid' mucosa that can be difficult to recognize as definitively colonic or enteric under the microscope. Furthermore, the ileal pouch mucosa undergoes a variety of histological and functional changes and is subject to a nonspecific inflammatory reaction known as 'pouchitis', an idiopathic phenomenon that can lead to pain, diarrhea, and bleeding when severe.…”

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confidence: 90%

CD10 immunohistochemistry stains enteric mucosa, but negative staining is unreliable in the setting of active enteritis

Lloyd

Owens

2011

Modern Pathology

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Ileal pouch-anal anastomosis is the definitive therapy for ulcerative colitis that is refractory to medical treatment or that has developed neoplasia. Patients with this procedure are routinely followed using directed endoscopic biopsies to monitor for dysplasia in the rectal cuff, residual/recurrent ulcerative colitis, and nonspecific acute inflammation of the ileal pouch (pouchitis), which have different clinical management and outcomes. Thus, accurate localization of mucosal biopsies is crucial to a definitive histological diagnosis, but is complicated by overlapping clinical presentations of pouchitis and ulcerative colitis, post-surgical and inflammatory changes to the mucosa, and altered endoscopic anatomy, resulting in difficulty determining whether a mucosal biopsy is ileal or rectal in origin for both the endoscopist and the pathologist. We explored the utility of CD10 immunohistochemistry to aid diagnosis in this clinical setting by highlighting the enteric mucosa, based on previous studies showing its utility in brush border staining and in the diagnosis of microvillous inclusion disease. We found uniformly positive CD10 immunostaining in normal enteric mucosa, but variable loss of expression in the setting of active enteritis. Specifically, CD10 staining was lost in up to 10% of the mucosa in 1/12 ileostomies and 4/13 enteric anastomoses, in 10-80% of the mucosa in 9/10 cases of Crohn's ileitis, in 10-60% of the mucosa in 7/16 ileal pouches, and in 20-90% of the mucosa in 6/8 cases of backwash ileitis, usually in the presence of active inflammation. There was no CD10 expression by normal or diseased colonic mucosa. Therefore, while CD10 immunostaining identifies normal enteric mucosa with 100% specificity, negative staining does not definitively exclude small intestinal mucosa in the setting of active enteritis, a common condition in ileal pouch mucosa.

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“…The main type of reconstruction after colectomy can be broadly divided into the straight ileo-anal anastomosis (SIAA) and the creation of a reservoir from an ileal pouch. The use of a pouch has become increasingly more popular because it appears to reduce the frequency of stooling [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%