Polyps in the Ileal Pouch

ABSTRACT

Total proctocolectomy and ileal pouch–anal anastomosis is the operation of choice for patients with familial adenomatous polyposis. With this operation comes the risk of developing ileal pouch polyps. Although rare, ileal pouch carcinomas may also occur within the pouch. Periodic endoscopic surveillance of the retained rectum and ileal pouch is recommended. Endoscopic polypectomy of medium and large polyps should be performed. Sulindac is effective in the reduction and often in the elimination of numerous smaller pouch polyps. Future studies are necessary to determine the role of sulindac and other chemotherapeutic agents in preventing the development of these polyps.

KEYWORDS

Polyps - ileal pouch - familial adenomatous polyposis

REFERENCES

• 1 Church J, Simmang C. Practice parameters for the treatment of patients with dominantly inherited colorectal cancer (familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer).  Dis Colon Rectum. 2003;  46(8) 1001-1012
• 2 Church J. Ileoanal pouch neoplasia in familial adenomatous polyposis: an underestimated threat.  Dis Colon Rectum. 2005;  48(9) 1708-1713
• 3 Beveridge I G, Swain D J, Groves C J et al.. Large villous adenomas arising in ileal pouches in familial adenomatous polyposis: report of two cases.  Dis Colon Rectum. 2004;  47(1) 123-126
• 4 Parc Y R, Olschwang S, Desaint B, Schmitt G, Parc R G, Tiret E. Familial adenomatous polyposis: prevalence of adenomas in the ileal pouch after restorative proctocolectomy.  Ann Surg. 2001;  233(3) 360-364
• 5 Moussata D, Nancey S, Lapalus M G et al.. Frequency and severity of ileal adenomas in familial adenomatous polyposis after colectomy.  Endoscopy. 2008;  40(2) 120-125
• 6 Groves C J, Beveridge G, Swain D J et al.. Prevalence and morphology of pouch and ileal adenomas in familial adenomatous polyposis.  Dis Colon Rectum. 2005;  48(4) 816-823
• 7 Cherki S, Glehen O, Moutardier V et al.. Pouch adenocarcinoma after restorative proctocolectomy for familial adenomatous polyposis.  Colorectal Dis. 2003;  5(6) 592-594
• 8 Bassuini M M, Billings P J. Carcinoma in an ileoanal pouch after restorative proctocolectomy for familial adenomatous polyposis.  Br J Surg. 1996;  83(4) 506
• 9 Nugent K P, Spigelman A D, Nicholls R J, Talbot I C, Neale K, Phillips R K. Pouch adenomas in patients with familial adenomatous polyposis.  Br J Surg. 1993;  80(12) 1620
• 10 Wu J S, McGannon E A, Church J M. Incidence of neoplastic polyps in the ileal pouch of patients with familial adenomatous polyposis after restorative proctocolectomy.  Dis Colon Rectum. 1998;  41(5) 552-556 discussion 556-557
• 11 Thompson-Fawcett M W, Marcus V A, Redston M, Cohen Z, McLeod R S. Adenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous polyposis.  Dis Colon Rectum. 2001;  44(3) 347-353
• 12 Church J M, Oakley J R, Wu J S. Pouch polyposis after ileal pouch-anal anastomosis for familial adenomatous polyposis: report of a case.  Dis Colon Rectum. 1996;  39(5) 584-586
• 13 Natori H, Utsunomiya J, Yamamura T, Benno Y, Uchida K. Fecal and stomal bile acid composition after ileostomy or ileoanal anastomosis in patients with chronic ulcerative colitis and adenomatosis coli.  Gastroenterology. 1992;  102(4 Pt 1) 1278-1288
• 14 Giardiello F M, Hamilton S R, Krush A J et al.. Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis.  N Engl J Med. 1993;  328(18) 1313-1316
• 15 Ho J W, Yuen S T, Chung L P, So H C, Kwan K Y. The role of sulindac in familial adenomatous polyposis patients with ileal pouch polyposis.  Aust N Z J Surg. 1999;  69(10) 756-758
• 16 Schulz A C, Bojarski C, Buhr H J, Kroesen A J. Occurrence of adenomas in the pouch and small intestine of FAP patients after proctocolectomy with ileoanal pouch construction.  Int J Colorectal Dis. 2008;  23(4) 437-441
• 17 Das P, Smith J J, Tekkis P P, Heriot A G, Antropoli M, John Nicholls R. Quality of life after indefinite diversion/pouch excision in ileal pouch failure patients.  Colorectal Dis. 2007;  9(8) 718-724
• 18 Saurin J C, Napoleon B, Gay G et al.. Endoscopic management of patients with familial adenomatous polyposis (FAP) following a colectomy.  Endoscopy. 2005;  37(5) 499-501
• 19 Mata A, Llach J, Castells A et al.. A prospective trial comparing wireless capsule endoscopy and barium contrast series for small-bowel surveillance in hereditary GI polyposis syndromes.  Gastrointest Endosc. 2005;  61(6) 721-725
• 20 Caspari R, von Falkenhausen M, Krautmacher C, Schild H, Heller J, Sauerbruch T. Comparison of capsule endoscopy and magnetic resonance imaging for the detection of polyps of the small intestine in patients with familial adenomatous polyposis or with Peutz-Jeghers' syndrome.  Endoscopy. 2004;  36(12) 1054-1059
• 21 Wong R F, Tuteja A K, Haslem D S et al.. Video capsule endoscopy compared with standard endoscopy for the evaluation of small-bowel polyps in persons with familial adenomatous polyposis (with video).  Gastrointest Endosc. 2006;  64(4) 530-537