Therapeutic Endoscopy in Postoperative Pouch Complications

Saurabh Chandan; Bo Shen; Gursimran S. Kochhar

doi:10.1055/s-0041-1740032

Clinics in Colon and Rectal Surgery, Table of Contents

Clin Colon Rectal Surg 2022; 35(01): 078-088
DOI: 10.1055/s-0041-1740032

Review Article

Therapeutic Endoscopy in Postoperative Pouch Complications

Saurabh Chandan

¹Gastroenterology and Hepatology, CHI Health Creighton University Medical Center, Omaha, Nebraska

,

Bo Shen

²Center for Ileal Pouch Disorders, Columbia University Irving Medical Center-NewYork Presbyterian Hospital, New York, New York

,

Gursimran S. Kochhar

³Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania

› Author Affiliations

Abstract

Ileal pouch-anal anastomosis (IPAA) or “J”-pouch as it is commonly referred to, is the treatment of choice in patients with medically refractory ulcerative colitis. IPAA can have infectious, inflammatory, and mechanical complications. Currently, there are no Food and Drug Administration-approved medical therapies for these complications. Surgery that may be eventually required can have significant morbidities due to the complexity of IPAA. Endoscopy is fast emerging as a leading modality of treatment for some of these pouch complications. Endoscopy in adjunct with medical treatment can help manage the majority of pouch-related disorders and improve the outcome.

Keywords

ileal pouch-anal anastomosis - Crohn's disease - ulcerative colitis

Full Text

References

References
1 Cima RR, Pemberton JH. Medical and surgical management of chronic ulcerative colitis. Arch Surg 2005; 140 (03) 300-310
2 Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1978; 2 (6130): 85-88
3 Melton GB, Kiran RP, Fazio VW. et al. Do preoperative factors predict subsequent diagnosis of Crohn's disease after ileal pouch-anal anastomosis for ulcerative or indeterminate colitis?. Colorectal Dis 2010; 12 (10) 1026-1032
4 Leinicke JA. Ileal pouch complications. Surg Clin North Am 2019; 99 (06) 1185-1196
5 Marcello PW, Roberts PL, Schoetz Jr DJ, Coller JA, Murray JJ, Veidenheimer MC. Obstruction after ileal pouch-anal anastomosis: a preventable complication?. Dis Colon Rectum 1993; 36 (12) 1105-1111
6 Fazio VW, Kiran RP, Remzi FH. et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 2013; 257 (04) 679-685
7 Lewis WG, Kuzu A, Sagar PM, Holdsworth PJ, Johnston D. Stricture at the pouch-anal anastomosis after restorative proctocolectomy. Dis Colon Rectum 1994; 37 (02) 120-125
8 Prudhomme M, Dozois RR, Godlewski G, Mathison S, Fabbro-Peray P. Anal canal strictures after ileal pouch-anal anastomosis. Dis Colon Rectum 2003; 46 (01) 20-23
9 Dietz DW. Mid pouch strictureplasty for Crohn's disease after ileal-pouch anal anastomosis: an alternative to pouch excision. Tech Coloproctol 2005; 9 (02) 179 , discussion 179
10 Francone TD, Champagne B. Considerations and complications in patients undergoing ileal pouch anal anastomosis. Surg Clin North Am 2013; 93 (01) 107-143
11 Lichtenstein GR, Feagan BG, Cohen RD. et al. Serious infections and mortality in association with therapies for Crohn's disease: TREAT registry. Clin Gastroenterol Hepatol 2006; 4 (05) 621-630
12 Lichtenstein GR, Olson A, Travers S. et al. Factors associated with the development of intestinal strictures or obstructions in patients with Crohn's disease. Am J Gastroenterol 2006; 101 (05) 1030-1038
13 Wu H, Shen B. Crohn's disease of the pouch: diagnosis and management. Expert Rev Gastroenterol Hepatol 2009; 3 (02) 155-165
14 Paine E, Shen B. Endoscopic therapy in inflammatory bowel diseases (with videos). Gastrointest Endosc 2013; 78 (06) 819-835
15 Lian L, Huang Q, Zhang L. et al. Anti-fibrogenic potential of mesenchymal stromal cells in treating fibrosis in Crohn's disease. Dig Dis Sci 2018; 63 (07) 1821-1834
16 Sabaté JM, Villarejo J, Bouhnik Y. et al. Hydrostatic balloon dilatation of Crohn's strictures. Aliment Pharmacol Ther 2003; 18 (04) 409-413
17 Brooker JC, Beckett CG, Saunders BP, Benson MJ. Long-acting steroid injection after endoscopic dilation of anastomotic Crohn's strictures may improve the outcome: a retrospective case series. Endoscopy 2003; 35 (04) 333-337
18 Nanda K, Courtney W, Keegan D. et al. Prolonged avoidance of repeat surgery with endoscopic balloon dilatation of anastomotic strictures in Crohn's disease. J Crohn's Colitis 2013; 7 (06) 474-480
19 Bessissow T, Reinglas J, Aruljothy A, Lakatos PL, Van Assche G. Endoscopic management of Crohn's strictures. World J Gastroenterol 2018; 24 (17) 1859-1867
20 Lee HW, Park SJ, Jeon SR. et al; Korean Association for the Study of the Intestinal Diseases (KASID). Long-term outcomes of endoscopic balloon dilation for benign strictures in patients with inflammatory bowel disease. Gut Liver 2018; 12 (05) 530-536
21 Taida T, Nakagawa T, Ohta Y. et al. Long-term outcome of endoscopic balloon dilatation for strictures in patients with Crohn's disease. Digestion 2018; 98 (01) 26-32
22 Navaneethan U, Lourdusamy V, Njei B, Shen B. Endoscopic balloon dilation in the management of strictures in Crohn's disease: a systematic review and meta-analysis of non-randomized trials. Surg Endosc 2016; 30 (12) 5434-5443
23 Fazio VW, Ziv Y, Church JM. et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 1995; 222 (02) 120-127
24 Hultén L. Problems after ileo-pouch anal anastomosis for ulcerative colitis. How can we prevent it? What can we do?. Neth J Med 1994; 45 (02) 80-85
25 Senapati A, Tibbs CJ, Ritchie JK, Nicholls RJ, Hawley PR. Stenosis of the pouch anal anastomosis following restorative proctocolectomy. Int J Colorectal Dis 1996; 11 (02) 57-59
26 Kirat HT, Kiran RP, Remzi FH, Fazio VW, Shen B. Diagnosis and management of afferent limb syndrome in patients with ileal pouch-anal anastomosis. Inflamm Bowel Dis 2011; 17 (06) 1287-1290
27 Fumery M, Patel NS, Boland BS, Dulai PS, Singh S, Sandborn WJ. Efficacy and safety of endoscopic balloon dilatation of ileoanal pouch strictures. Inflamm Bowel Dis 2018; 24 (06) 1316-1320
28 Shen B, Fazio VW, Remzi FH. et al. Endoscopic balloon dilation of ileal pouch strictures. Am J Gastroenterol 2004; 99 (12) 2340-2347
29 Shen B, Lian L, Kiran RP. et al. Efficacy and safety of endoscopic treatment of ileal pouch strictures. Inflamm Bowel Dis 2011; 17 (12) 2527-2535
30 Wu XR, Mukewar S, Kiran RP, Remzi FH, Shen B. Surgical stricturoplasty in the treatment of ileal pouch strictures. J Gastrointest Surg 2013; 17 (08) 1452-1461
31 Gao DJ, Hu B, Pan YM. et al. Feasibility of using wire-guided needle-knife electrocautery for refractory biliary and pancreatic strictures. Gastrointest Endosc 2013; 77 (05) 752-758
32 Samanta J, Dhaka N, Sinha SK, Kochhar R. Endoscopic incisional therapy for benign esophageal strictures: technique and results. World J Gastrointest Endosc 2015; 7 (19) 1318-1326
33 Coelho-Prabhu N, Dzeletovic I, Baron TH. Outcome of access sphincterotomy using a needle knife converted from a standard biliary sphincterotome. Endoscopy 2012; 44 (07) 711-714
34 Lan N, Shen B. Endoscopic stricturotomy with needle knife in the treatment of strictures from inflammatory bowel disease. Inflamm Bowel Dis 2017; 23 (04) 502-513
35 Lan N, Wu JJ, Wu XR, Hull L T, Shen B. Endoscopic treatment of pouch inlet and afferent limb strictures: stricturotomy vs. balloon dilation. Surg Endosc 2021; 35 (04) 1722-1733
36 Bettenworth D, Gustavsson A, Atreja A. et al. A pooled analysis of efficacy, safety, and long-term outcome of endoscopic balloon dilation therapy for patients with stricturing Crohn's disease. Inflamm Bowel Dis 2017; 23 (01) 133-142
37 Shen B, Kochhar G, Navaneethan U. et al; Global Interventional Inflammatory Bowel Disease Group. Role of interventional inflammatory bowel disease in the era of biologic therapy: a position statement from the Global Interventional IBD Group. Gastrointest Endosc 2019; 89 (02) 215-237
38 Chen M, Shen B. Endoscopic therapy in Crohn's disease: principle, preparation, and technique. Inflamm Bowel Dis 2015; 21 (09) 2222-2240
39 Schwartz DA, Tagarro I, Carmen Díez M, Sandborn WJ. Prevalence of fistulizing Crohn's disease in the United States: estimate from a systematic literature review attempt and population-based database analysis. Inflamm Bowel Dis 2019; 25 (11) 1773-1779
40 Nisar PJ, Kiran RP, Shen B, Remzi FH, Fazio VW. Factors associated with ileoanal pouch failure in patients developing early or late pouch-related fistula. Dis Colon Rectum 2011; 54 (04) 446-453
41 Kochhar G, Shen B. Endoscopic fistulotomy in inflammatory bowel disease (with video). Gastrointest Endosc 2018; 88 (01) 87-94
42 Lan N, Shen B. Endoscopic fistulotomy vs. redo surgery for the treatment of pouch-to-pouch fistula in patients with inflammatory bowel disease: 916. Am J Gastroenterol 2019; 114: S535-S536
43 Raju GS. Endoscopic clip closure of gastrointestinal perforations, fistulae, and leaks. Dig Endosc 2014; 26 (Suppl. 01) 95-104
44 Haito-Chavez Y, Law JK, Kratt T. et al. International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc 2014; 80 (04) 610-622
45 Sze G, Khan F, Shen B. Combined endoscopic fistulotomy and clipping for the treatment of fistula from the tip of the J-pouch to anastomosis. ACG Case Rep J 2019; 6 (03) 1-3
46 Molendijk I, Bonsing BA, Roelofs H. et al. Allogeneic bone marrow-derived mesenchymal stromal cells promote healing of refractory perianal fistulas in patients with Crohn's disease. Gastroenterology 2015; 149 (04) 918-27.e6
47 Panés J, García-Olmo D, Van Assche G. et al; ADMIRE CD Study Group Collaborators. Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn's disease: a phase 3 randomised, double-blind controlled trial. Lancet 2016; 388 (10051): 1281-1290
48 Lee WY, Park KJ, Cho YB. et al. Autologous adipose tissue-derived stem cells treatment demonstrated favorable and sustainable therapeutic effect for Crohn's fistula. Stem Cells 2013; 31 (11) 2575-2581
49 Cho YB, Lee WY, Park KJ, Kim M, Yoo HW, Yu CS. Autologous adipose tissue-derived stem cells for the treatment of Crohn's fistula: a phase I clinical study. Cell Transplant 2013; 22 (02) 279-285
50 Dietz AB, Dozois EJ, Fletcher JG. et al. Autologous mesenchymal stem cells, applied in a bioabsorbable matrix, for treatment of perianal fistulas in patients with Crohn's disease. Gastroenterology 2017; 153 (01) 59-62.e2
51 Sahami S, Buskens CJ, Fadok TY. et al. Defunctioning ileostomy is not associated with reduced leakage in proctocolectomy and ileal pouch anastomosis surgeries for IBD. J Crohn's Colitis 2016; 10 (07) 779-785
52 MacRae HM, McLeod RS, Cohen Z, O'Connor BI, Ton EN. Risk factors for pelvic pouch failure. Dis Colon Rectum 1997; 40 (03) 257-262
53 Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW. Endoluminal vacuum therapy for the treatment of anastomotic leakage after anterior rectal resection. Rozhl Chir 2008; 87 (08) 397-402
54 Smallwood NR, Fleshman JW, Leeds SG, Burdick JS. The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations. Surg Endosc 2016; 30 (06) 2473-2480
55 Leeds SG, Burdick JS. Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obes Relat Dis 2016; 12 (07) 1278-1285
56 Gubler C, Schneider PM, Bauerfeind P. Complex anastomotic leaks following esophageal resections: the new stent over sponge (SOS) approach. Dis Esophagus 2013; 26 (06) 598-602
57 Gardenbroek TJ, Musters GD, Buskens CJ. et al. Early reconstruction of the leaking ileal pouch-anal anastomosis: a novel solution to an old problem. Colorectal Dis 2015; 17 (05) 426-432
58 Rottoli M, Di Simone MP, Vallicelli C. et al. Endoluminal vacuum-assisted therapy as treatment for anastomotic leak after ileal pouch-anal anastomosis: a pilot study. Tech Coloproctol 2018; 22 (03) 223-229
59 Kochhar GS, Shen B. Endoscopic treatment of leak at the tip of the “J” ileal pouch. Endosc Int Open 2017; 5 (01) E64-E66
60 Akbari RP, Madoff RD, Parker SC. et al. Anastomotic sinuses after ileoanal pouch construction: incidence, management, and outcome. Dis Colon Rectum 2009; 52 (03) 452-455
61 Ahmed Ali U, Shen B, Remzi FH, Kiran RP. The management of anastomotic pouch sinus after IPAA. Dis Colon Rectum 2012; 55 (05) 541-548
62 Shen B, Remzi FH, Lavery IC, Lashner BA, Fazio VW. A proposed classification of ileal pouch disorders and associated complications after restorative proctocolectomy. Clin Gastroenterol Hepatol 2008; 6 (02) 145-158 , quiz 124
63 Whitlow CB, Opelka FG, Gathright Jr JB, Beck DE. Treatment of colorectal and ileoanal anastomotic sinuses. Dis Colon Rectum 1997; 40 (07) 760-763
64 Nyam DC, Wolff BG, Dozois RR, Pemberton JH, Mathison SM. Does the presence of a pre-ileostomy closure asymptomatic pouch-anastomotic sinus tract affect the success of ileal pouch-anal anastomosis?. J Gastrointest Surg 1997; 1 (03) 274-277
65 Swain BT, Ellis CN. Fibrin glue treatment of low rectal and pouch-anal anastomotic sinuses. Dis Colon Rectum 2004; 47 (02) 253-255
66 Korsgen S, Nikiteas N, Ogunbiyi OA, Keighley MR. Results from pouch salvage. Br J Surg 1996; 83 (03) 372-374
67 Remzi FH, Aytac E, Ashburn J. et al. Transabdominal redo ileal pouch surgery for failed restorative proctocolectomy: lessons learned over 500 patients. Ann Surg 2015; 262 (04) 675-682
68 Abild N, Bulut O, Nielsen CB. Endoscopic stapled marsupialisation of chronic presacral sinus following low anterior resection: a simple option in selected cases. Scand J Surg 2012; 101 (04) 307-310
69 Sloothaak DA, Buskens CJ, Bemelman WA, Tanis PJ. Treatment of chronic presacral sinus after low anterior resection. Colorectal Dis 2013; 15 (06) 727-732
70 van Koperen PJ, van Berge Henegouwen MI, Rosman C. et al. The Dutch multicenter experience of the endo-sponge treatment for anastomotic leakage after colorectal surgery. Surg Endosc 2009; 23 (06) 1379-1383
71 Lian L, Geisler D, Shen B. Endoscopic needle knife treatment of chronic presacral sinus at the anastomosis at an ileal pouch-anal anastomosis. Endoscopy 2010; 42 (Suppl. 02) E14
72 Li Y, Shen B. Successful endoscopic needle knife therapy combined with topical doxycycline injection of chronic sinus at ileal pouch-anal anastomosis. Colorectal Dis 2012; 14 (04) e197-e199
73 Wu XR, Wong RCK, Shen B. Endoscopic needle-knife therapy for ileal pouch sinus: a novel approach for the surgical adverse event (with video). Gastrointest Endosc 2013; 78 (06) 875-885
74 Lan N, Shen B. Endoscopic treatment of ileal pouch sinus. Inflamm Bowel Dis 2018; 24 (07) 1510-1519
75 Lan N, Hull TL, Shen B. Endoscopic sinusotomy versus redo surgery for the treatment of chronic pouch anastomotic sinus in ulcerative colitis patients. Gastrointest Endosc 2019; 89 (01) 144-156
76 Lan N, Zhang L, Shen B. Post-index procedural gain in body mass index is associated with recurrent ileal pouch sinus after endoscopic or surgical therapy. Surg Endosc 2020; 34 (05) 2127-2135