Neoplastic transformation of the pelvic pouch mucosa in patients with ulcerative colitis

Gullberg, Kjell; Ståhlberg, Dagny; Liljeqvist, L; Tribukait, Bernhard; Fp, Reinholt; Veress, B; Löfberg, Robert

doi:10.1016/s0016-5085(97)70029-5

Cited by 173 publications

(122 citation statements)

References 4 publications

Supporting

Mentioning

113

Contrasting

Unclassified

Order By: Relevance

“…For IPAA several reports have documented atypia, dysplasia, different molecular aberrations, as well as genetic changes [18,21,22,25]. In our study of 45 patients operated with IPAA followed for 18 years, besides atrophy, inflammation and change of mucins towards sulphomucins, only 2 patients demonstrated low-grade dysplasia ( Figure 7) [18].…”

Section: Restorative Proctocolectomy -Ileopouch Anal Anastomosis (Ipaa)mentioning

confidence: 51%

“…Even if cell changes, dysplasia and DNA aberrations occur in all types it is the type C that is claimed to demonstrate the highest frequency of erosions, inflammatory changes and subsequent development of dysplasia and carcinoma. In a series of papers the Veress group have described all these features including DNA aneuploidy and genetic aberrations except carcinoma [22,25]. In our group CI patients were followed for 30 years [23].…”

Section: Discussionmentioning

confidence: 98%

“…A case of adenocarcinoma in the CI [10] and sporadic reports of dysplasia in the ileal pouch mucosa have currently appeared in the literature, suggesting that the morphologi- Figure 3. Cumulative probability of cancer development in longstanding total colitis before (upper curve [3]) and after IRA surgery (lower curve [23] cal transformation of the ileal pouch mucosa might result in cellular dysplasia and eventually carcinoma [21,22]. The atrophic colon-like mucosa in the ileal pouch is hypothetically considered a potentially premalignant condition with risk for subsequent development of advanced neoplastic transformation.…”

Section: Restorative Proctocolectomy -Ileopouch Anal Anastomosis (Ipaa)mentioning

confidence: 99%

“…Grading of dysplasia was according to established international criteria [24]. Morphological changes in the different forms of pouch mucosa were grouped into three types according to Veress et al [22,25]. Type A: 51%, normal mucosa and few inflammatory cells.…”

Section: Restorative Proctocolectomy -Ileopouch Anal Anastomosis (Ipaa)mentioning

confidence: 99%

See 3 more Smart Citations

Prophylactic Surgery for Patients with Longstanding Ulcerative Colitis. Which Option? Histopathological and Clinical Implications

Wïllén

Agnarsdóttir²,

Hultén³

2007

Upsala Journal of Medical Sciences

View full text Add to dashboard Cite

Patients with longstanding chronic ulcerative proctocolitis are at risk to develop colorectal cancer Conflicting views as regards surveillance, the indications for surgery and type of preventive procedure exist. For permanent prevention of cancer development complete removal of all potential malignant colorectal mucosa has to be done. Panprocto-colectomy with a conventional ileostomy or continent ileostomy removing all colorectal mucosa should therefore eliminate further risks of colorectal cancer.Colectomy and ileorectal anastomosis is a controversial issue. While many surgeons today are reluctant to use the technique, emphasising the persistent cancer risk, others consider the operation a viable alternative when used on a selective basis. The long-term risk of cancer in the rectal stump is the main strong argument .In restorative proctocolectomy, i.e. proctocolectomy with construction of an ileopouch anal anastomosis residual rectal mucosa is left behind irrespective of technique used and is therefore at risk for cancer development. Quite a few cancers have been reported to occur in these patients but controversy exists as regards the origin of these tumours but the risk for cancer development is very low.Biopsies from ileal pouches demonstrate various histopathological changes from nearly normal mucosa, to inflammation and atrophy, inflammatory cell changes, dysplasia as well as development of carcinoma. Grading of type and atypia is a challenge to reproduce and requires the participation of experienced gastrointestinal histopathologists.

show abstract

Section: Restorative Proctocolectomy -Ileopouch Anal Anastomosis (Ipaa)mentioning

confidence: 51%

Section: Discussionmentioning

confidence: 98%

Section: Restorative Proctocolectomy -Ileopouch Anal Anastomosis (Ipaa)mentioning

confidence: 99%

Section: Restorative Proctocolectomy -Ileopouch Anal Anastomosis (Ipaa)mentioning

confidence: 99%

See 2 more Smart Citations

Prophylactic Surgery for Patients with Longstanding Ulcerative Colitis. Which Option? Histopathological and Clinical Implications

Wïllén

Agnarsdóttir²,

Hultén³

2007

Upsala Journal of Medical Sciences

View full text Add to dashboard Cite

show abstract

“…Ileal pouch-anal anastomosis without ileostomy is relatively safe if the patient and the family clearly accept the risk of an early postoperative anastomotic leakage 2 . There is still the risk of neoplastic transformation in the pouch, mainly in cases of chronic pouchitis 27,28 or in the remaining anal mucosa. Ileal pouchanal anastomosis requires regular surveillance 24 .…”

mentioning

confidence: 99%

Short- and long-term outcomes of ileal pouch-anal anastomosis for ulcerative colitis

et al. 2003

View full text Add to dashboard Cite

Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results. PATIENTS AND METHODS:Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up. RESULTS:The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41) occurred in 34 patients (42.5%). Late complications (29) occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8%) 1 year after ileal pouch-anal anastomosis, 9 (14.8%) after 3 years, 13 (21.3%) after 5 years, and 16 (26.2%) after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later.CONCLUSIONS: Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up.

show abstract

Current Controversies in the Surgical Management of Ulcerative Colitis

Nicholls¹,

Cheetham²

2006

Challenges in Inflammatory Bowel Disease

View full text Add to dashboard Cite

Neoplastic transformation of the pelvic pouch mucosa in patients with ulcerative colitis

Cited by 173 publications

References 4 publications

Prophylactic Surgery for Patients with Longstanding Ulcerative Colitis. Which Option? Histopathological and Clinical Implications

Prophylactic Surgery for Patients with Longstanding Ulcerative Colitis. Which Option? Histopathological and Clinical Implications

Short- and long-term outcomes of ileal pouch-anal anastomosis for ulcerative colitis

Current Controversies in the Surgical Management of Ulcerative Colitis

Contact Info

Product

Resources

About