Endoscopy 2008; 40(6): 529-533
DOI: 10.1055/s-2007-995784
Expert approach

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopy in the management of patients after ileal pouch surgery for ulcerative colitis

D.  S.  Pardi1 , B.  Shen2
  • 1Fiterman Center for Digestive Diseases, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
  • 2Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio
Further Information

Publication History

Publication Date:
08 May 2008 (online)

Pouchitis is the most common complication following ileal pouch-anal anastomosis in patients with ulcerative colitis. However, there are several other inflammatory and noninflammatory conditions that can mimic pouchitis, and endoscopy with biopsies is essential for distinguishing these various conditions. This paper will review the differential diagnosis of pouchitis and the role of endoscopy in the diagnosis and management of disorders of the ileal pouch.

References

  • 1 Fazio V W, Ziv Y, Church J M. et al . Ileal pouch-anal anastomosis: complications and function in 1005 patients.  Ann Surg. 1995;  222 120-127
  • 2 Sandborn W J. Pouchitis following ileal pouch-anal anastomosis: definition, pathogenesis and treatment.  Gastroenterology. 1994;  107 1856-1860
  • 3 Simchuk E J, Thirlby R C. Risk factors and true incidence of pouchitis in patients after ileal pouch-anal anastomoses.  World J Surg. 2000;  24 851-856
  • 4 Salemans J M, Nagengast F M, Lubbers E J, Kuijpers J H. Postoperative and long-term results of ileal pouch-anal anastomosis for ulcerative colitis and familial polyposis coli.  Dig Dis Sci. 1992;  37 1882-1889
  • 5 Marcello P W, Roberts P L, Schoetz Jr D J. et al . Long-term results of the ileoanal pouch procedure.  Arch Surg. 1993;  128 500-503; discussion 503-504
  • 6 Meagher A P, Farouk R, Dozois R R. et al . J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients.  Br J Surg. 1998;  85 800-803
  • 7 Svaninger G, Nordgren S, Oresland T, Hulten L. Incidence and characteristics of pouchitis in the Kock continent ileostomy and the pelvic pouch.  Scand J Gastroenterol. 1993;  28 695-700
  • 8 Pardi D S, Sandborn W J. Systematic review: the management of pouchitis.  Aliment Pharmacol Ther. 2006;  23 1087-1096
  • 9 Shen B, Fazio V W, Remzi F H. et al . Comprehensive evaluation of inflammatory and noninflammatory sequelae of ileal pouch-anal anastomoses.  Am J Gastroenterol. 2005;  100 93-101
  • 10 Shen B, Lashner B A, Bennett A E. et al . Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis.  Am J Gastroenterol. 2004;  99 1527-1531
  • 11 Thompson-Fawcett M W, Mortensen N J, Warren B F. ”Cuffitis” and inflammatory changes in the columnar cuff, anal transitional zone, and ileal reservoir after stapled pouch-anal anastomosis.  Dis Colon Rectum. 1999;  42 348-355
  • 12 Shen B, Fazio V W, Remzi F H. et al . Clinical features and quality of life in patients with different phenotypes of Crohn’s disease of the ileal pouch.  Dis Colon Rectum. 2007;  [Epub ahead of print]
  • 13 Munoz-Juarez M, Pemberton J H, Sandborn W J. et al . Misdiagnosis of specific cytomegalovirus infection of the ileoanal pouch as refractory idiopathic chronic pouchitis: report of two cases.  Dis Colon Rectum. 1999;  42 117-120
  • 14 Moonka D, Furth E E, MacDermott R P, Lichtenstein G R. Pouchitis associated with primary cytomegalovirus infection.  Am J Gastroenterol. 1998;  93 264-266
  • 15 Salfiti N, Loftus E V, Tremaine W J. et al . Clinical features and outcomes of cytomegalovirus colitis or pouchitis in patients with inflammatory bowel disease.  Am J Gastroenterol. 2005;  100 S316
  • 16 Shen B, Goldblum J R, Hull T L. et al . Clostridium difficile-associated pouchitis.  Dig Dis Sci. 2006;  51 2361-2364
  • 17 Shen B, Achkar J P, Lashner B A. et al . Irritable pouch syndrome: a new category of diagnosis for symptomatic patients with ileal pouch-anal anastomosis.  Am J Gastroenterol. 2002;  97 972-977
  • 18 Sagar P M, Pemberton J H. Ileo-anal pouch function and dysfunction.  Dig Dis. 1997;  15 172-188
  • 19 Di Febo G, Miglioli M, Lauri A. et al . Endoscopic assessment of acute inflammation of the ileal reservoir after restorative ileo-anal anastomosis.  Gastrointest Endosc. 1990;  36 6-9
  • 20 Moskowitz R L, Shepherd N A, Nicholls R J. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir.  Int J Colorect Dis. 1986;  1 167-174
  • 21 Shen B, Shermock K M, Fazio V W. et al . A cost-effectiveness analysis of diagnostic strategies for symptomatic patients with ileal pouch-anal anastomosis.  Am J Gastroenterol. 2003;  98 2460-2467
  • 22 Shen B, Achkar J P, Lashner B A. et al . Endoscopic and histologic evaluation together with symptom assessment are required to diagnose pouchitis.  Gastroenterology. 2001;  121 261-267
  • 23 Knupper N, Straub E, Terpe H J, Vestweber K H. Adenocarcinoma of the ileoanal pouch for ulcerative colitis - a complication of severe chronic atrophic pouchitis?.  Int J Colorectal Dis. 2006;  21 478-482
  • 24 Shepherd N A, Jass J R, Duval I. et al . Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens.  J Clin Pathol. 1987;  40 601-607
  • 25 Schwartz D A, White C M, Wise P E, Herline A J. Use of endoscopic ultrasound to guide combination medical and surgical therapy for patients with Crohn’s perianal fistulas.  Inflamm Bowel Dis. 2005;  11 727-732
  • 26 Schaus B J, Fazio V W, Remzi F H. et al . Clinical features of ileal pouch polyps in patients with underlying ulcerative colitis.  Dis Colon Rectum. 2007;  50 832-838
  • 27 Tysk C, Schnürer L B, Wickbom G. Obstructing inflammatory fibroid polyp in pelvic ileal reservoir after restorative proctocolectomy in ulcerative colitis. Report of a case.  Dis Colon Rectum. 1994;  37 1034-1037
  • 28 Shen B, Fazio V W, Remzi F H. et al . Endoscopic balloon dilation of ileal pouch strictures.  Am J Gastroenterol. 2004;  99 2340-2347
  • 29 Matzke G M, Kang A S, Dozois E J, Sandborn W J. Mid pouch strictureplasty for Crohn’s disease after ileal pouch-anal anastomosis: an alternative to pouch excision.  Dis Colon Rectum. 2004;  47 782-786
  • 30 Nilubol N, Scherl E, Bub D S. et al . Mucosal dysplasia in ileal pelvic pouches after restorative proctocolectomy.  Dis Colon Rectum. 2007;  50 825-831
  • 31 Das P, Johnson M W, Tekkis P P, Nicholls R J. Risk of dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis.  Colorect Dis. 2007;  9 15-27
  • 32 Freeman H. Dysplasia-associated polypoid mucosal lesion in a pelvic pouch after restorative proctocolectomy for ulcerative colitis.  Can J Gastroenterol. 2001;  15 485-488
  • 33 Negi S S, Chaudhary A, Gondal R. Carcinoma of pelvic pouch following restorative proctocolectomy: report of a case and review of the literature.  Dig Surg. 2003;  20 63-65
  • 34 Laureti S, Ugolini F, D’Errico A. et al . Adenocarcinoma below ileoanal anastomosis for ulcerative colitis: report of a case and review of the literature.  Dis Colon Rectum. 2002;  45 418-421
  • 35 Hyman N. Rectal cancer as a complication of stapled IPAA.  Inflamm Bowel Dis. 2002;  8 43-45
  • 36 Sarigol S, Wyllie R, Gramlich T. et al . Incidence of dysplasia in pelvic pouches in pediatric patients after ileal pouch-anal anastomosis for ulcerative colitis.  J Pediat Gastroenterol Nutr. 1999;  28 429-434
  • 37 Veress B, Reinholt F P, Lindquist K. et al . Long-term histomorphological surveillance of the pelvic ileal pouch: dysplasia develops in a subgroup of patients.  Gastroenterology. 1995;  109 1090-1097
  • 38 Gullberg K, Stahlberg D, Liljeqvist L. et al . Neoplastic transformation of the pelvic pouch mucosa in patients with ulcerative colitis.  Gastroenterology. 1997;  112 1487-1492
  • 39 Heuschen U A, Heuschen G, Autschbach F. et al . Adenocarcinoma in the ileal pouch: late risk of cancer after restorative proctocolectomy.  Int J Colorect Dis. 2001;  16 126-130
  • 40 Coull D B, Lee F D, Henderson A P. et al . Risk of dysplasia in the columnar cuff after stapled restorative proctocolectomy.  Br J Surg. 2003;  90 72-75
  • 41 Herline A J, Meisinger L L, Rusin L C. et al . Is routine pouch surveillance for dysplasia indicated for ileoanal pouches?.  Dis Colon Rectum. 2003;  46 156-159
  • 42 Thompson-Fawcett M W, Marcus V, Redston M. et al . Risk of dysplasia in long-term ileal pouches and pouches with chronic pouchitis.  Gastroenterology. 2001;  121 275-281
  • 43 Remzi F H, Fazio V W, Delaney C P. et al . Dysplasia of the anal transitional zone after ileal pouch-anal anastomosis: results of prospective evaluation after a minimum of ten years.  Dis Colon Rectum. 2003;  46 6-13
  • 44 Gilchrist K W, Harms B A, Starling J R. Abnormal rectal mucosa of the anal transitional zone in ulcerative colitis.  Arch Surg. 1995;  130 981-983
  • 45 Scarpa M, van Koperen P J, Ubbink D T. et al . Systematic review of dysplasia after restorative proctocolectomy for ulcerative colitis.  Br J Surg.. 2007;  94 534-545
  • 46 Kariv R, Bennett A, Kariv Y, Fazio V, Lavery I, Lashner B, Shen B, Remzi F. Adenocarcinoma in the ileal pouch-anal Anastomosis: The Cleveland Clinic Experience.  Am J Gastrol. 2007;  102 A953
  • 47 Loftus Jr E V. Epidemiology and risk factors for colorectal dysplasia and cancer in ulcerative colitis.  Gastroenterol Clin N Am. 2006;  35 517-531
  • 48 Shen B, Fu A ZH, Lashner B. et al . Surveillance pouch endoscopy for the detection of dysplasia in ulcerative colitis patients with ileal-pouch anal anastomosis is cost-effective [abstract].  Am J Gastroenterol. 2007;  102 S461

D. S. Pardi, MD 

200 First Street SW
Rochester
MN 55905
USA

Fax: +1-507-284-5486

Email: pardi.darrell@mayo.edu

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