Endoscopic Features Associated with Ileal Pouch Failure

Abstract

Distorted appearance of "beak" portion of owl's eyes along with Crohn's disease of the pouch or surgery-related complications, postoperative use of biologics, and persistent cuffitis were the risk factors associated with pouch failure. The assessment of endoscopic owl's eye structure may provide an additional clue to predict pouch outcome.

Review of long‐term complications and functional outcomes of ileoanal pouch procedures in patients with inflammatory bowel disease

“…Other post-operative risk factors significantly associated with pouch failure and chronic pouchitis included biologic use, 28,42 early pouchitis onset 23 and abnormal endoscopic findings. 28 There are several limitations to this review. All but one of the included studies are retrospective and heterogeneity across studies is high with respect to disease phenotype, underlying type of IBD, surgical indication (emergency vs. elective) and technique.…”

“…15,22,28,41,42 Six studies reported incidence of post-operative immunosuppression use ranging from 3% to 15.5% (median 6.75%, IQR: 3.2-9.3%) with a mean follow-up of 9.4 years. 15,22,28,41,42 Many patients post-IAPP remained on motility agents (loperamide, cholestyramine and domperidone), with rates reported as 47%, 43 50%, 44 66.2% 32 and 68.8%. 45 Nyabanga et al 41 reported approximately a third of patients used probiotics or NSAIDS post-operatively, whilst Netz et al 22 reported nearly half (47%) of IAPP patients required some sort of medication post-operatively.…”

Diagnosis and Management of Cuffitis: A Systematic Review

“…Cuffitis is also associated with the development of pouchitis, 23 pouch failure, 2,24 and pouch excision. 4,25 In the authors' experience, chronic cuffitis, especially nonclassic cuffitis‚ may be a contributing factor to the development of cryptoglandular fistulas or anovaginal fistulas.…”

Diagnosis and Management of Idiopathic Pouchitis

“…Other endoscopic findings more common in chronically inflamed pouches could include inflammatory polyps and loss of owl's eye configuration with poor distensibility of the pouch. 6,8 Histological findings of acute pouchitis could include neutrophil infiltration along with crypt abscesses and ulcerations. Chronic pouchitis could reveal the presence of chronic inflammatory cell infiltration as well as villous atrophy, crypt hyperplasia, and distortion and pyloric metaplasia.…”