Ileal Pouch Anal Anastomosis (IPAA) for colitis; development of Crohn's and Pouchitis

Kolbeinsson, Hordur M.; Wall, Tyler; Bayat, Aqieda; Luchtefeld, Martin; Ogilvie, James W.

doi:10.1016/j.amjsurg.2022.01.018

Cited by 10 publications

(12 citation statements)

References 28 publications

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“…Reported CDP incidence ranged from 7.8% to 20.9% (median 15.2%, IQR: 10%–18.75%) with a mean follow‐up time of 8.4 years 6,7,16,17,26,28,35,39,40 …”

Section: Resultsmentioning

confidence: 99%

“…Reported pouch fistula incidence ranged from 2.5 to 15.8% (median 11.3%, IQR: 5-13.7%) with a mean follow-up time of 10.1 years. 4,6,7,16,21,24,26,29,32,33,35,38 Crohn's disease of the pouch (CDP)…”

Section: Neoplasm Of the Pouchmentioning

confidence: 99%

“…Reported CDP incidence ranged from 7.8% to 20.9% (median 15.2%, IQR: 10%-18.75%) with a mean follow-up time of 8.4 years. 6,7,16,17,26,28,35,39,40 Cuffitis Four studies reported incidences of cuffitis defined as clinical symptoms characteristic of cuffitis as well as endoscopic evidence of inflammation of the remnant rectal cuff.…”

Section: Neoplasm Of the Pouchmentioning

confidence: 99%

“…Reported chronic pouchitis incidence ranged from 7.3% to 31% (median 17.1%, IQR: 12-23.6%) with a mean follow-up time of 9.8 years. 4,6,7,[15][16][17][18][19][20][21][22][23][24][25][26]…”

Section: Chronic Pouchitismentioning

confidence: 99%

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

Hassan

Connell

Rawal

et al. 2023

ANZ Journal of Surgery

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Background In medically refractory Ulcerative Colitis (UC), proctocolectomy with ileoanal pouch procedure (IAPP) is the preferred continence‐preserving surgical option. Functional outcomes post‐surgery and long‐term complication rates in the biologic era remain ambiguous. This review primarily aims to provide an update on these outcomes. Secondarily, risk factors associated with chronic pouchitis and pouch failure are explored. Methods Two online databases (MEDLINE and EMBASE) were searched on 4 October 2022 for English studies from 2011‐present relating to long‐term outcomes of IAPP in inflammatory bowel disease (IBD) patients. Adult patients with 12 month follow‐up were included. Studies focused on 30‐day post‐operative outcomes, non‐IBD patients or studies including less than 30 patients were excluded. Results Following screening and full‐text review of 1094 studies, 49 were included. Median sample size was n = 282 (IQR: 116–519). Median incidences for chronic pouchitis and pouch failure were 17.1% (IQR: 12–23.6%) and 6.9% (IQR: 4.8–10.8%), respectively. Upon multivariate analysis, chronic pouchitis development was most significantly associated with pre‐operative steroid use, pancolitis and extra‐intestinal IBD manifestations, whilst pouch failure was most significantly associated with pre‐operative diagnosis of Crohn's disease (compared to UC), peri‐operative pelvic sepsis and anastomotic leak. Overall patient satisfaction was very high with four included studies reporting greater than 90% satisfaction rates. Conclusion Long‐term complications for IAPP were common. However, despite this, patient satisfaction post‐IAPP was high. Up‐to‐date knowledge of complication rates and their risk factors improves pre‐operative counselling, management planning and patient outcomes.

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“…Reported CDP incidence ranged from 7.8% to 20.9% (median 15.2%, IQR: 10%–18.75%) with a mean follow‐up time of 8.4 years 6,7,16,17,26,28,35,39,40 …”

Section: Resultsmentioning

confidence: 99%

Section: Neoplasm Of the Pouchmentioning

confidence: 99%

Section: Neoplasm Of the Pouchmentioning

confidence: 99%

“…Reported chronic pouchitis incidence ranged from 7.3% to 31% (median 17.1%, IQR: 12-23.6%) with a mean follow-up time of 9.8 years. 4,6,7,[15][16][17][18][19][20][21][22][23][24][25][26]…”

Section: Chronic Pouchitismentioning

confidence: 99%

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

Hassan

Connell

Rawal

et al. 2023

ANZ Journal of Surgery

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“…The most feared long-term outcome after IPAA is pouch failure, defined as permanent intestinal diversion or pouch excision. Rates of pouch failure range from 5% to 9.1% within 10 years after final surgical stage at high volume institutions, and increase to as high as 9%-18% beyond 10 years [2][3][4]. The rate of pouch failure may be decreasing with time, with one systematic review documenting the incidence of pouch failure to be 13% between 2002 and 2009 and only 2% between 2010 and 2015 [5].…”

Section: Introductionmentioning

confidence: 99%

Predictors of pouch failure: A tertiary care inflammatory bowel disease centre experience

et al. 2023

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Aim: Rates of pouch failure after total proctocolectomy with ileal pouch−anal anastomosis (IPAA) range from 5% to 18%. There is little consistency across studies regarding the factors associated with failure, and most include patients who underwent IPAA in the pre-biologic era. Our aim was to analyse a cohort of patients who underwent IPAA in the biologic era at a large-volume inflammatory bowel disease institution to better determine preoperative, perioperative and postoperative factors associated with pouch failure.Methods: A retrospective cohort analysis was performed with data from an institutional review board approved prospective database with ulcerative colitis or unclassified inflammatory bowel disease patients who underwent total proctocolectomy with IPAA at Mount Sinai Hospital between 2008 and 2017. Preoperative, perioperative and postoperative data were collected and univariate and multivariate analyses were performed to identify factors associated with increased risk of pouch failure.Results: Out of 664 patients included in the study, pouch failure occurred in 41 (6.2%) patients, a median of 23.3 months after final surgical stage. Of these, 17 (41.4%) underwent pouch excision and 24 (58.5%) had diverting ileostomies. The most common indications for pouch failure were Crohn's disease like pouch inflammation (CDLPI) (n = 17, 41.5%), chronic pouchitis (n = 6, 14.6%), chronic cuffitis (n = 5, 12.2%) and anastomotic stricture (n = 4, 9.8%). On multivariate analysis, pre-colectomy biologic use (hazard ratio [HR] 2.25,

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Long-term behavior and functional outcomes of ileal-pouch anal anastomosis in inflammatory bowel disease with changing phenotype

Macleod,

Parks,

Cook

et al. 2024

Surgery

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Ileal Pouch Anal Anastomosis (IPAA) for colitis; development of Crohn's and Pouchitis

Cited by 10 publications

References 28 publications

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

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

Predictors of pouch failure: A tertiary care inflammatory bowel disease centre experience

Long-term behavior and functional outcomes of ileal-pouch anal anastomosis in inflammatory bowel disease with changing phenotype

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