Risk of Rectal Neoplasia after Colectomy and Ileorectal Anastomosis for Ulcerative Colitis

Uzzan, Mathieu; Kirchgesner, Julien; Oubaya, Nadia; Amiot, Aurélien; Gornet, Jean–Marc; Seksik, Philippe; Nancey, Stéphane; Cotte, Eddy; Allez, Matthieu; Boschetti, Gilles; Laharie, David; Angelis, Nicola De; Nachury, Maria; Pelletier, Anne-Laure; Abitbol, Véred; Fuméry, Mathurin; Brouquet, Antoine; Buisson, Anthony; Altwegg, Romain; Cosnes, Jacques

doi:10.1093/ecco-jcc/jjx027

Cited by 42 publications

(39 citation statements)

References 16 publications

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“…Pouch dysfunction can occur following surgery and can be caused by pouchitis, cuffitis, irritable pouch syndrome, CD, or pouch fistula. Pouch failure requiring surgery and removal of pouch can sometimes occur [372] and diagnosis depends on endoscopic and histological findings in conjunction with symptoms [376]. Some patients with symptoms of pouchitis will not have inflammation, but rather, irritable pouch syndrome [372].…”

Section: Caring For the Patient With An Ileoanal Pouch N-ecco Statemementioning

confidence: 99%

Second N-ECCO Consensus Statements on the European Nursing Roles in Caring for Patients with Crohn’s Disease or Ulcerative Colitis

Kemp

Dibley

Chauhan

et al. 2018

Journal of Crohn's and Colitis

142

150

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This is the second Nurse European Crohns and Colitis (N-ECCO) consensus statements document addressing inflammatory bowel disease (IBD) nursing across Europe. N-ECCO continues to be an active member of European Crohns and Colitis Organisation (ECCO), providing education and networking opportunities for nurses across Europe within three designated nurse sessions, N-ECCO Network Meeting, N-ECCO School and the N-ECCO Research Forum, in addition to e-learning and podcasts. 1.1 Aim The over-arching aim of ECCO is to improve the care of patients with IBD through the development of guidelines, education and research. Current evidence is fundamental to enable N-ECCO to meet this progressive aim. This document updates the first N-ECCO consensus statements based on the 'ideal' standard of care [1], and provides additional statements and evidence supporting contemporary IBD nursing practice, whilst acknowledging the extensive variety in IBD nursing practice across Europe [2].

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Section: Caring For the Patient With An Ileoanal Pouch N-ecco Statemementioning

confidence: 99%

Second N-ECCO Consensus Statements on the European Nursing Roles in Caring for Patients with Crohn’s Disease or Ulcerative Colitis

Kemp

Dibley

Chauhan

et al. 2018

Journal of Crohn's and Colitis

142

150

View full text Add to dashboard Cite

show abstract

“…The function following conversion of an IRA to a pouch seems reasonable in patients with familial adenomatous polyposis, and probably in patients with UC . Another disadvantage with IRA is the potential risk of cancer, and yearly surveillance of the rectal remnant is needed .…”

Section: Discussionmentioning

confidence: 99%

“…The function following conversion of an IRA to a pouch seems reasonable in patients with familial adenomatous polyposis, and probably in patients with UC [19,20]. Another disadvantage with IRA is the potential risk of cancer, and yearly surveillance of the rectal remnant is needed [21,22]. IRAs have the perceived advantage of being less technically demanding and, in combination with careful patient selection and medical management of the rectal remnant, may represent an interim measure for some patients requiring colectomy.…”

Section: Discussionmentioning

confidence: 99%

Restorative surgery after colectomy for ulcerative colitis in England and Sweden: observations from a comparison of nationwide cohorts

et al. 2018

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Following colectomy for UC only one-third of English patients and half of Swedish patients underwent restorative surgery. In England nearly all these patients underwent pouches, in Sweden a less significant majority underwent IRAs. It is surprising to demonstrate this discrepancy in a comparable cohort of patients from similar healthcare systems. The causes and consequences of this international variation in management are not fully understood and require further investigation.

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“…Several studies have shown safety of IRA for UC with overall complications ranging from 24% to 28% and anastomotic leak rate of 3-4% [67][68][69]. Long-term failure rate is the most important concern and ranges from 18% to 49% [67,[69][70][71]. In a recent multicenter retrospective study of 343 patients undergoing IRA in France, multivariable analysis identified treatment with both immunosuppressants and anti-TNF before colectomy as independent predictors of IRA failure, whereas colectomy for severe acute colitis was associated with a decreased risk of IRA failure [72].…”

Section: Ileorectal Anastomosismentioning

confidence: 99%

Ulcerative Colitis: Surgical Management

Zaghiyan

Fleshner

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Multidisciplinary management and early surgical referral are crucial in the management of ulcerative colitis patients with moderate to severe colitis. While dysplasia screening and management is changing, surgical referral remains a cornerstone in the management of multifocal and highgrade dysplasia.• Ileal pouch-anal anastomosis is the standard surgery for medically refractory disease, cancer, or dysplasia. One, two, or three-stage surgery may be chosen and tailored to various patient factors including preoperative nutritional status, corticosteroid use, and intraoperative factors. • Alternative approaches such as total proctocolectomy with end ileostomy, continent ileostomy, and ileorectal anastomosis are options that may be considered in select patients. • Long-term functional outcomes of patients undergoing surgery for ulcerative colitis including bowel, sexual, and urinary function, as well as fertility preservation, are important considerations and should be discussed preoperatively and monitored closely in the postoperative setting.

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Risk of Rectal Neoplasia after Colectomy and Ileorectal Anastomosis for Ulcerative Colitis

Abstract: The risk of rectal carcinoma in patients with IRA for UC remains, and this justifies long-term endoscopic surveillance. Either IPAA or end ileostomy should be considered in 'high-risk' patients i.e. those with PSC and/or with prior colonic neoplasia.

Cited by 42 publications

References 16 publications

Second N-ECCO Consensus Statements on the European Nursing Roles in Caring for Patients with Crohn’s Disease or Ulcerative Colitis

Second N-ECCO Consensus Statements on the European Nursing Roles in Caring for Patients with Crohn’s Disease or Ulcerative Colitis

Restorative surgery after colectomy for ulcerative colitis in England and Sweden: observations from a comparison of nationwide cohorts

Ulcerative Colitis: Surgical Management

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