Stratifying Risks of Ileal Pouch Outcomes

Akiyama, Shintaro; Rodriguez, Tina G.; Rubin, David T.

doi:10.1016/j.cgh.2021.08.051

Cited by 3 publications

(5 citation statements)

References 3 publications

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“…Regarding endoscopic phenotypes in this patient cohort, the most frequent overall phenotype was cuffitis (74%), followed by focal inflammation (70%), IL involvement (43%), AL involvement (35%), diffuse inflammation (30%), and pouch fistula (13%). The number of endoscopic examinations per patient was similar between the 2 groups (high HID group, 11 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] examinations; low HID group, 11.5 [9][10][11][12][13][14] examinations). The proportions of patients with diffuse inflammation or pouch fistula in the high HID group (46%) was 2-fold higher than in the low HID group (20%).…”

Section: Higher Proportion Of Sulfomucin-producing Gcs In Diffuse Inf...mentioning

confidence: 80%

“…Each phenotype had distinct contributing factors and was associated with different clinical outcomes, with the “diffuse inflammation of the pouch body” phenotype significantly associated with the need for pouch excision [ 12 ]. Accordingly, the Chicago classification may have utility in stratifying patients according to the risk of pouch loss using standardized endoscopic assessments and thereby guide intensive follow-up and medical prophylaxis to improve clinical outcomes in patients with IPAA [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…12 Accordingly, the Chicago classification may have utility in stratifying patients according to the risk of pouch loss using standardized endoscopic assessments and thereby guide intensive follow-up and medical prophylaxis to improve clinical outcomes in patients with IPAA. 13,14 Although there are limited data regarding the pathological mechanisms underlying poor outcomes in patients with IPAA, previous studies have reported colonic metaplasia of intestinal goblet cells (GCs) is associated with the development of pouchitis in UC. Intestinal GCs play an important role in the secretion of mucins and maintenance of the mucous gel layer which provides protection for the surface epithelium.…”

Section: Introductionmentioning

confidence: 99%

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Association of colonic metaplasia of goblet cells and endoscopic phenotypes of the J pouch in patients with ulcerative colitis: a retrospective pilot study

Akiyama,

Onoda,

Moue

et al. 2024

Intest Res

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Background/Aims: Mucosal adaptation of the ileum toward colonic epithelium has been reported in pouchitis in ulcerative colitis (UC); however, the clinical characteristics, endoscopic findings, and outcomes in patients with pouchitis with ileal mucosal adaptation are poorly understood.Methods: This was a single-center retrospective study comprising UC patients treated by proctocolectomy with ileal pouch-anal anastomosis who had undergone pouchoscopy at the University of Tsukuba Hospital between 2005 and 2022. Endoscopic phenotypes were evaluated according to the Chicago classification. High-iron diamine staining (HID) was performed to identify sulfomucin (colon-type mucin)-producing goblet cells (GCs) in pouch biopsies. We compared clinical data between patients with (high HID group) and without > 10% sulfomucin-producing GCs in at least one biopsy (low HID group).Results: We reviewed 390 endoscopic examination reports from 50 patients. Focal inflammation was the most common phenotype (78%). Five patients (10%) required diverting ileostomy. Diffuse inflammation and fistula were significant risk factors for diverting ileostomy. The median proportion of sulfomucin-producing GCs on histological analysis of 82 pouch biopsies from 23 patients was 9.9% (range, 0%–93%). The duration of disease was significantly greater in the high HID group compared to the low HID group. The median percentage of sulfomucin-producing GCs was significantly higher in patients with diffuse inflammation or fistula compared to other endoscopic phenotypes (14% vs. 6.0%, <i>P</i>= 0.011).Conclusions: Greater proportions of sulfomucin-producing GCs were observed in endoscopic phenotypes associated with poor outcomes in UC, indicating patients with pouchitis showing colonic metaplasia of GCs may benefit from early interventions.

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Section: Higher Proportion Of Sulfomucin-producing Gcs In Diffuse Inf...mentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of colonic metaplasia of goblet cells and endoscopic phenotypes of the J pouch in patients with ulcerative colitis: a retrospective pilot study

Akiyama,

Onoda,

Moue

et al. 2024

Intest Res

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“… 15 These studies suggest that standardized endoscopic examinations according to an observation of each anatomical location of the J pouch may allow for the stratifying of patients based on the risk of pouch loss and can guide appropriate monitoring to improve pouch outcomes in patients with UC. 19 , 20 …”

Section: Introductionmentioning

confidence: 99%

“…All these studies highlight that the standardized and reliable endoscopic evaluation using pouchoscopy is important to stratify patients at higher risk of developing chronic pouchitis and pouch loss, and may provide an appropriate therapeutic approach to improve pouch‐related QOL in patients with UC. 19 , 20 …”

Section: Introductionmentioning

confidence: 99%

Endoscopic assessment of the J pouch in ulcerative colitis: A narrative review

Akiyama,

Barnes,

Onoda

et al. 2024

DEN Open

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Patients with ulcerative colitis sometimes need a total colectomy with ileal pouch‐anal anastomosis due to medically refractory disease or colitis‐associated neoplasia. Up to 50% of patients with ulcerative colitis postoperatively develop pouchitis and the rate of chronic inflammatory pouch conditions requiring pouch excision or diverting ileostomy is reported to be 10%. In order to diagnose and monitor pouchitis, pouchoscopy is essential to assess endoscopic inflammatory findings of the J pouch and to survey neoplasia development, particularly in the remnant distal rectum. However, endoscopic protocols for the evaluation of the pouch may not be standardized worldwide and the reliability of existing disease activity indices for pouchitis has been questioned due to the lack of validation. Recently, reliable endoscopic scoring systems based on an observation of the anatomical location of the J pouch were reported and a significant association between the distribution pattern of endoscopic inflammation (i.e., endoscopic phenotype) and pouch outcomes was also uncovered. In this review, we discuss how to survey the J pouch using pouchoscopy, endoscopic indices for pouchitis disease activity, endoscopic phenotypes and classification, and the pathological mechanisms of pouchitis phenotype in patients with ulcerative colitis.

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Barnes

2022

Clinical Gastroenterology and Hepatology

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Stratifying Risks of Ileal Pouch Outcomes

Cited by 3 publications

References 3 publications

Association of colonic metaplasia of goblet cells and endoscopic phenotypes of the J pouch in patients with ulcerative colitis: a retrospective pilot study

Association of colonic metaplasia of goblet cells and endoscopic phenotypes of the J pouch in patients with ulcerative colitis: a retrospective pilot study

Endoscopic assessment of the J pouch in ulcerative colitis: A narrative review

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