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

Hernández, Jorge D. Meléndez; Jiménez-Huyke, Carlos; Rosado, Kathia; González-Keelan, Carmen; Lojo, Juan; Torres, Esther A.

doi:10.1007/s10620-009-1006-y

Cited by 15 publications

(2 citation statements)

References 22 publications

(23 reference statements)

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“…zur Surveillance mindestens alle 2 Jahre durchgeführt werden. [5,37] Dabei sollte die Tiefe der Inspektion (Pouch/neoterminales Ileum) angegeben werden und die Mukosa im neoterminalen Ileum, im Pouch und im ggf. vorhandenen rektalen Cuff beschrieben werden.…”

Section: Pouchoskopieunclassified

Positionspapier zur Befunderstellung endoskopischer Untersuchungen bei Patienten mit chronisch-entzündlichen Darmerkrankungen

et al. 2021

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ZusammenfassungDie vollständige und reproduzierbare Erfassung und Dokumentation endoskopischer Befunde ist als Grundlage der Behandlung von Patienten mit chronisch entzündlichen Darmerkrankungen wie Morbus Crohn und Colitis ulcerosa von entscheidender Bedeutung. Diese Befunde sind zum einen Grundlage therapeutischer Entscheidungen und zum anderen ein unverzichtbarer Parameter der Bewertung des Ansprechens auf eine Behandlung. Endoskopische Befunde sollten daher nach standardisierten Kriterien erstellt werden, um eine Vergleichbarkeit der Befunde unterschiedlicher Untersucher wie auch die valide Erfassung von Veränderungen im zeitlichen Verlauf der Erkrankung zu gewährleisten. Vor diesem Hintergrund haben 15 Mitglieder der AG Bildgebung des Kompetenznetzes Darmerkrankungen ein Positionspapier erarbeitet, in dem eine Befundstruktur für die Dokumentation endoskopischer Untersuchungen entworfen wird. Die Empfehlungen adressieren neben den formalen Angaben zu jeder Untersuchung insbesondere eine Vielzahl von Attributen akuter und chronisch entzündlicher mukosaler Veränderungen sowie endoskopisch detektierbarer Komplikationen, die detailliert erläutert und anhand charakteristischer Abbildungen illustriert werden. Zudem werden häufiger verwendete endoskopische Aktivitätsindizes vorgestellt, und ihre Nutzung im klinischen Alltag wird diskutiert.

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Section: Pouchoskopieunclassified

Positionspapier zur Befunderstellung endoskopischer Untersuchungen bei Patienten mit chronisch-entzündlichen Darmerkrankungen

et al. 2021

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“…Nearly one-third of patients with chronic ulcerative colitis (UC) will eventually require surgical intervention [1,2]. Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is currently the gold standard in surgical treatment and is also the most common procedure in the treatment of UC patients because it preserves continence and attempts to remove all disease-prone mucosa [3,4]. The 3-stage IPAA includes (1) colectomy, (2) proctectomy with ileoanal anastomosis (J pouch creation) and diversion loop ileostomy, and (3) ileostomy reversal or takedown.…”

Section: Introductionmentioning

confidence: 99%

Routine Pouchoscopy Prior to Ileostomy Takedown May Not Be Necessary in Patients with Chronic Ulcerative Colitis

Cai¹,

Barrow²,

Parian³

et al. 2017

Dig Dis

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Background: Creation of a J pouch is the gold standard surgical intervention in the treatment of chronic ulcerative colitis (UC). Pouchoscopy prior to ileostomy takedown is commonly performed. We describe the frequency, indication, and findings on pouchoscopy, and determine if pouchoscopy affects rates of complications after takedown. Methods: All UC or indeterminate inflammatory bowel disease patients with a J pouch were retrospectively evaluated from January 1994 to December 2014. Cases were defined as having routine (asymptomatic) pouchoscopy after pouch creation but before ileostomy takedown. Controls were defined as having no pouchoscopy or pouchoscopy on the same day as that of takedown. Results: The study included 178 patients (81.5% cases, 18.5% controls). Fifty two percent of pouchoscopies were reported as normal. Common abnormal endoscopy findings included stricture (35%), pouchitis (7%), and cuffitis (0.7%). Length of stay during takedown hospitalization was shorter for cases than controls (3 vs. 5 days; p = 0.001), but neither short- nor long-term complications were statistically different between cases and controls. Abnormalities on pouchoscopy were not predictive for short-term complications (p = 0.73) or long-term complications (p = 0.55). Routine pouchoscopy did not delay takedown surgery in any of the included patients. Conclusions: Routine pouchoscopy may not be necessary prior to ileostomy takedown; its greatest utility is in patients with suspected pouch complications.

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Diagnosis and management of dysplasia and cancer of the ileal pouch in patients with underlying inflammatory bowel disease

Liu

Kiran

Bennett

et al. 2011

Cancer

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Approximately 30% of the patients with ulcerative colitis (UC) would ultimately require colectomy for medically refractory UC or UC‐associated neoplasia. Restorative proctocolectomy with ileal pouch‐anal anastomosis has become the surgical treatment of choice for these patients. However, this procedure does not completely abolish the risk for neoplasia of the pouch. The main risk factor for pouch neoplasia is a preoperative diagnosis of UC‐associated dysplasia or cancer. Although the natural history and prognosis of pouch dysplasia are not clear, mortality associated with pouch cancer, once diagnosed, appears to be high. Conversely, not all pouch neoplasia follows the chronic inflammation‐dysplasia‐cancer sequence, which makes pouch endoscopy with biopsy, the current gold standard for surveillance, challenging. In addition, the findings that pouch neoplasia is not common and that pouch endoscopy still misses dysplasia lead to controversy on the need and time interval of routine endoscopic surveillance. However, based on reports in the literature and their own experience, the authors recommend surveillance endoscopy to be performed in patients at risk, such as those with a precolectomy diagnosis of UC‐associated neoplasia. This review appraises issues in the prevalence and incidence, risk factors, technical aspects of pouch construction, clinical and pathological features, natural history, surveillance examination, diagnosis, and management of pouch neoplasia. Cancer 2011. © 2011 American Cancer Society.

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

Cited by 15 publications

References 22 publications

Positionspapier zur Befunderstellung endoskopischer Untersuchungen bei Patienten mit chronisch-entzündlichen Darmerkrankungen

Positionspapier zur Befunderstellung endoskopischer Untersuchungen bei Patienten mit chronisch-entzündlichen Darmerkrankungen

Routine Pouchoscopy Prior to Ileostomy Takedown May Not Be Necessary in Patients with Chronic Ulcerative Colitis

Diagnosis and management of dysplasia and cancer of the ileal pouch in patients with underlying inflammatory bowel disease

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