Evaluation of endoscopic and imaging modalities in the diagnosis of structural disorders of the ileal pouch

Tang, Linda; Cai, Hui; Moore, Lauren; Shen, Bo

doi:10.1002/ibd.21199

Cited by 34 publications

(10 citation statements)

References 12 publications

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“…All modalities were similar in diagnosing outlet strictures with accuracy rates of 87.9% to 92.3%. 34 Another study found GGE to be 100% sensitive (6/6) and 92% specific (33/36) in finding post-IPAA strictures at an anastomotic diameter of ≤8 mm. 35 GGE appears to be particularly useful in diagnosing ileal pouch strictures.…”

Section: Resultsmentioning

confidence: 98%

Endoscopic Therapy for Pouch Leaks and Strictures: A Systematic Review

Lee

Shen

2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND:Patients with ulcerative colitis refractory to medication or familial adenomatous polyposis may require ileal pouch-anal anastomosis after a colectomy. IPAA is generally well tolerated. However, patients can experience posttreatment complications, including pouch strictures and leaks. Medical therapy has a limited role in mechanical fibrotic strictures, whereas surgery is invasive and costly. In the past few decades, endoscopic therapies have provided a less invasive and less costly intervention for pouch strictures and leaks. OBJECTIVE:This systematic literature review aimed to describe the status of advancements in endoscopic therapy for pouch leaks and strictures. DATA SOURCES:The sources used were PubMed and Cochrane databases.

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Section: Resultsmentioning

confidence: 98%

Endoscopic Therapy for Pouch Leaks and Strictures: A Systematic Review

Lee

Shen

2022

Diseases of the Colon &Amp; Rectum

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“…As such, pouchoscopy is required both for the diagnosis of pouchitis and to exclude other conditions such as CDL phenotype or structural abnormalities of the pouch. 30 This procedure involves assessment of the rectal cuff, pouch body, and prepouch ileum (afferent limb). However, despite endoscopic evaluation being the most objective measure of pouch activity, standardized and reliable descriptors of endoscopic disease activity do not currently exist.…”

Section: Challenges With Measuring Pouchitis Disease Activitymentioning

confidence: 99%

Measurement of Disease Activity of Pouchitis

Chis

Silverberg

2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Pouchitis is the most common inflammatory complication in ulcerative colitis patients undergoing postoperative construction of an IPAA. Pouchitis refers to a spectrum of diseases, and as such, it lacks a universally accepted definition as well as validated instruments to measure disease activity and treatment response. Assessing pouchitis activity is challenging, and methods for diagnosis and classification of severity of pouchitis are not universally agreed upon. CLINICAL FEATURES:Pouchitis is characterized by a constellation of clinical symptoms, including increased stool frequency, urgency, incontinence, bleeding, and rarely constitutional symptoms such as malaise and lowgrade fever. However, these symptoms are subjective, and similar symptoms can be caused by noninflammatory conditions including anal sphincter dysfunction, anastomotic strictures, occult leaks, pouch inlet obstruction, and cuffitis. Objective scores that include endoscopic and histologic criteria have been developed for subjects with an IPAA. However, these instruments are not validated for measuring pouchitis disease activity and are associated with a number of challenges. In addition, the clinical components of the scores correlate poorly with endoscopic and histologic findings. CONCLUSION AND FUTURE DIRECTIONS:There is a need for prospective studies to facilitate the development and validation of novel instruments that are valid, reliable, and responsive to change that would facilitate the development of therapeutic agents for the treatment of pouchitis.

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“…Sinuses that persist despite these measures can be very difficult to manage for the surgeon and both morbid and frustrating for the patient. Contrast studies of the pouch, pelvic MRI, and EUA are helpful for further delineation of the tract [29]. Treatment begins with periodic incision and drainage of the sinus with healing by secondary intention over a course of usually 6-9 months.…”

Section: Pouch-anal Anastomotic (Paa) Defectmentioning

confidence: 99%