Factors Associated With Surgical Outcome of Ileal Pouch-Anal Anastomosis When Intentionally Used in Crohn's Disease

Le, Quy; Melmed, Gil Y.; Murrell, Zuri; Vasiliauskas, Eric A.; Shih, David Q.; Dubinsky, Marla; Ippoliti, Andrew; Targan, Stephan R.; Fleshner, Phillip

doi:10.1016/s0016-5085(11)63254-x

Cited by 4 publications

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“…Although patients with UC generally have good functional results after IPAA, 1,2 the diagnosis of Crohn's disease (CD) significantly increases the risk of pouch complications. [2][3][4][5] De novo CD is one of the most devastating complications occurring in 5 to 10 per cent of patients after IPAA and may lead to ultimate pouch failure. [6][7][8][9][10] Although UC and CD are typically distinguished by meticulous clinical, endoscopic, and histopathologic assessment of endoscopic biopsy or surgical specimens, indeterminate colitis (IC) and inflammatory bowel disease unspecified (IBDU) are diagnosed when there is inadequate diagnostic criteria to distinguish between UC and CD.…”

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confidence: 99%

De novo Crohn's Disease after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis and Inflammatory Bowel Disease Unclassified: Long-Term Follow-Up of a Prospective Inflammatory Bowel Disease Registry

Zaghiyan

Kamiński

Barmparas

et al. 2016

The American Surgeon™

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The risk of de novo Crohn's disease (CD) after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) versus inflammatory bowel disease unclassified (IBDU) or indeterminate colitis (IC) remains debatable. Here, we present updated results after long-term follow-up of a previously studied cohort of 334 patients with UC, IBDU, or IC who underwent IPAA during a 10-year period ending 2007. Of 334 study patients, 56 per cent were male and median age was 38 years (range: 8–81). Patients were classified as UC (n = 237) or IBDU (n = 97) preoperatively and UC (n = 236) or IC (n = 98) postoperatively. After a median follow-up of 76 months (range: 3–236), 63 patients (19%) developed CD within a median of 22 months (range: 1–213) from ileostomy closure compared with the previously published 40 patients (12%) with 26-month follow-up ( P = 0.01). The development of de novo CD was similar for patients undergoing IPAA for UC (n = 40; 17%), IBDU (n = 21; 22%) or those classified as having UC (n = 42; 18%) or IC (n = 19; 19%) postoperatively; P > 0.05. Thus, patients with IBDU and IC can expect equivalent long-term outcome to patients with UC after IPAA. Pouch failure occurred in 13 (4%) study patients and was equal among all four groups.

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confidence: 99%

De novo Crohn's Disease after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis and Inflammatory Bowel Disease Unclassified: Long-Term Follow-Up of a Prospective Inflammatory Bowel Disease Registry

Zaghiyan

Kamiński

Barmparas

et al. 2016

The American Surgeon™

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“…IPAA for UC-indicate that these patients may have acceptable outcomes after IPAA. [10][11][12][13][14] In a case-control study published in 1996, Panis et al were the first to specifically address pouch outcomes in patients with primary CD in absence of ileal and perianal disease. They found a pouch failure rate (10%) was not significantly different from that in patients with UC.…”

Section: What Is the Role Of Restorative Pouchmentioning

confidence: 99%

“…1,5,7,[11][12][13][14] However, when considering IPAA in patients with primary CD, it is important to note that in comparison to patients with UC, patients with a preoperative diagnosis of CD may be at significantly increased risk of developing CD of the pouch (15.9 vs. 63.5%, p ¼ 0.003 reported by Shen et al and 11 vs. 41%, p ¼ 0.002 described by Le et al). 13,14 As such, CD-related pouch complications are relatively common (29-64%). 7,[11][12][13][14] Even so, pouch failure is infrequent (6-15%) 7,11-14 (►Table 1).…”

Section: What Is the Role Of Restorative Pouchmentioning

confidence: 99%

“…13,14 As such, CD-related pouch complications are relatively common (29-64%). 7,[11][12][13][14] Even so, pouch failure is infrequent (6-15%) 7,11-14 (►Table 1).…”

Section: What Is the Role Of Restorative Pouchmentioning

confidence: 99%

“…1,2,[4][5][6][7][8]12 De novo Crohn's occurs in 0.7 to 15.9% of patients after IPAA performed for UC. 13,14,26,28,34 Differences in reported prevalence are likely related to dissimilarities in diagnostic criteria, length of follow-up, and regional practice patterns. As such, the true prevalence of CD of the pouch is unknown.…”

Section: What Is the Role Of Restorative Pouch Procedures In Indetermmentioning

confidence: 99%

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Is There a Role for Ileal Pouch Anal Anastomosis in Crohn's Disease?

Lopez

Zaghyian

Fleshner

2019

Clinics in Colon and Rectal Surgery

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Traditionally, surgical interventions for colonic Crohn's disease (CD) have been limited to total abdominal colectomy and ileorectal anastomosis, or total proctocolectomy with end ileostomy if there is rectal involvement. However, improved understandings of the biology of CD, as well as the development of biologic therapies, have enabled more limited resections. Here, we review the indications for, and limitations of, specific procedures aiming to preserve intestinal continuity in colonic CD.

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Crohn's of the Pouch: Now What?

Connelly

Lincango

Holubar

2022

Clin Colon Rectal Surg

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Total proctocolectomy and ileal pouch anal anastomosis (IPAA) is the gold standard surgical treatment for the majority (∼90%) of ulcerative colitis (UC) patients. In cases of carefully selected Crohn's colitis patients without small bowel or perianal involvement an “intentional IPAA” may be a viable option for disease resection and restoration of intestinal continuity. More commonly, Crohn's is incidentally found either in the resection specimen or, more commonly, when inflammatory complications subsequently arise after pouch construction for UC or indeterminate colitis. These incidental Crohn's pouches may be diagnosed early or late period post-IPAA.Crohn's may manifest within the pouch, in the proximal small bowel, and/or distally in the rectal cuff or anus. Like intestinal Crohn's, Crohn's disease of the pouch may be of an inflammatory, fibrostenosing, or fistulizing phenotype. Treatment depends on the phenotype and includes medical treatment, most commonly in the form of tumor necrosis factor inhibitor medications; however, the newer small molecules offer a potential treatment for these patients. Surgery first entails treating the sequelae of Crohn's and is typically staged. In up to 60% of Crohn's pouches, particularly in fistulizing disease and/or recalcitrant perianal disease, the pouch fails and must be defunctioned or excised. In patients with Crohn's pouches in situ long term, outcomes including quality of life are comparable to patients who underwent IPAA for UC.

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Factors Associated With Surgical Outcome of Ileal Pouch-Anal Anastomosis When Intentionally Used in Crohn's Disease

Cited by 4 publications

References 0 publications

De novo Crohn's Disease after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis and Inflammatory Bowel Disease Unclassified: Long-Term Follow-Up of a Prospective Inflammatory Bowel Disease Registry

De novo Crohn's Disease after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis and Inflammatory Bowel Disease Unclassified: Long-Term Follow-Up of a Prospective Inflammatory Bowel Disease Registry

Is There a Role for Ileal Pouch Anal Anastomosis in Crohn's Disease?

Crohn's of the Pouch: Now What?

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