Therapeutic Endoscopy in Postoperative Pouch Complications

Chandan, Saurabh; Shen, Bo; Kochhar, Gursimran

doi:10.1055/s-0041-1740032

Cited by 6 publications

(7 citation statements)

References 78 publications

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“…In another series of 8 patients, complete healing of leak was documented in median 2 months-time [79]. Hence EVT can be used for anastomotic leak post IPAA whereas OTSC is to be used if there is leak without any abscess [7].…”

Section: Pouch Leaksmentioning

confidence: 97%

“…Endoscopic fistulotomy can be used in short (< 3 cm), superficial (<2 cm thick), simple fistulas like pouch-to-pouch body fistula, perianal fistula and ileo-cecal fistula Role of Interventional IBD in Management of Ulcerative Colitis(UC)-Associated Neoplasia and… DOI: http://dx.doi.org/10.5772/intechopen.106599 [7]. In a study of 29 patients (26 IPAA, 21 having UC) with IBD related fistulas, endoscopic fistulotomy (EFT) with needle knife was successful in healing fistula in nearly 90% patients whereas 10% require surgical intervention [80].…”

Section: Pouch Fistulamentioning

confidence: 99%

“…Endoscopic placement of clips is useful in controlling leaks from pouch. Endoscopic resection can be done for large symptomatic inflammatory polyps in the pouch or polyps in the rectal cuff [2,7]. We aimed to systematically review all the relevant literature pertaining to endoscopic management of UCAN and pouch complications post IPAA.…”

Section: Introductionmentioning

confidence: 99%

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Role of Interventional IBD in Management of Ulcerative Colitis(UC)-Associated Neoplasia and Post-Operative Pouch Complications in UC: A Systematic Review

Pal¹,

Banerjee²,

Ramchandani³

et al. 2022

Ulcerative Colitis - Etiology, Diagnosis, Diet, Special Populations, and the Role of Interventional Endoscopy

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Interventional inflammatory bowel disease (IIBD) is going to play a major role in complex IBD including ulcerative-colitis associated neoplasia (UCAN) and postoperative complications after ileal pouch-anal anastomosis (IPAA) in ulcerative colitis (UC). We performed a literature search in PubMed using keywords such as “UCAN” and “endoscopic management of pouch complications,” After screening 1221 citations, finally, 91 relevant citations were identified for the systematic review. Endoscopic recognition of dysplasia should be done by high-definition white light endoscopy (HD-WLE) or dye-based/virtual chromoendoscopy (CE) especially in known dysplasia or primary sclerosing cholangitis (PSC). Endoscopically visible lesions without deep submucosal invasion can be resected endoscopically with endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or using full-thickness resection device (FTRD). Image-enhanced endoscopy (IEE) and IIBD have an emerging role in screening, diagnosis, and management of colitis-associated neoplasia in UC and can avoid colectomy. IIBD can manage a significant proportion of post-IPAA complications. Pouch strictures can be treated with endoscopic balloon dilation (EBD) or stricturotomy, whereas acute and chronic anastomotic leak or sinuses can be managed with through the scope (TTS)/over the scope clips (OTSC) and endoscopic fistulotomy/sinusotomy.

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Section: Pouch Leaksmentioning

confidence: 97%

Section: Pouch Fistulamentioning

confidence: 99%

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Role of Interventional IBD in Management of Ulcerative Colitis(UC)-Associated Neoplasia and Post-Operative Pouch Complications in UC: A Systematic Review

Pal¹,

Banerjee²,

Ramchandani³

et al. 2022

Ulcerative Colitis - Etiology, Diagnosis, Diet, Special Populations, and the Role of Interventional Endoscopy

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“…They can be fibrotic or nonfibrotic (inflammatory) in nature (60). Strictures can be due to ischemia, intraoperative technical difficulties, nonsteroidal anti-inflammatory drug use, or CLDP (10,62,63). Complications from strictures include bowel obstruction, evacuation disorders, pouch dilatation, and bacterial overgrowth (63).…”

Section: Stricturesmentioning

confidence: 99%

“…Despite a reported rate of 38% of stricture frequency in a consecutive series (61), more recent studies observed stricture formation in up to 11.2% of the patients (1,60). Typical locations include the pouch-anal anastomosis, midpouch, and pouch inlet (Figure 4) (10,62). They can be fibrotic or nonfibrotic (inflammatory) in nature (60).…”

Section: Structural Pouch Disordersmentioning

confidence: 99%

Classification and Management of Disorders of the J Pouch

2023

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Total abdominal proctocolectomy with ileal pouch–anal anastomosis (IPAA) for ulcerative colitis (UC) is associated with substantial complications despite the benefits of managing refractory and/or neoplasia-associated disease. For the purpose of this review, we focused on the diagnosis of some of the most common inflammatory and structural pouch disorders and their respective management. Pouchitis is the most common complication, and it is typically responsive to antibiotics. However, chronic antibiotic refractory pouchitis (CARP) has been increasingly recognized, and biologic therapies have emerged as the mainstay of therapy. Crohn's-like disease of the pouch (CLDP) can affect up to 10% of patients with UC after IPAA. Medical options are similar to CARP therapies, including biologics with immunomodulators. Studies have shown higher efficacy rates of biologics for CLDP when compared with those for CARP. In addition, managing stricturing and fistulizing CLDP is challenging and often requires interventional endoscopy (balloon dilation and/or stricturotomy) and/or surgery. The implementation of standardized diagnostic criteria for inflammatory pouch disorders will help in advancing future therapeutic options. Structural pouch disorders are commonly related to surgical complications after IPAA. We focused on the diagnosis and management of anastomotic leaks, strictures, and floppy pouch complex. Anastomotic leaks and anastomotic strictures occur in approximately 15% and 11% of patients with UC after IPAA, respectively. Further complications from pouch leaks include the development of sinuses, fistulas, and pouch sepsis requiring excision. Novel endoscopic interventions and less invasive surgical procedures have emerged as options for the management of these disorders.

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