TY - JOUR
T1 - Current Practices in Ileal Pouch Surveillance for Patients With Ulcerative Colitis: A Multinational, Retrospective Cohort Study
T2 - A Multinational, Retrospective Cohort Study
AU - Samaan, Mark A.
AU - Forsyth, Katrina
AU - Segal, Jonathan P.
AU - de Jong, Djuna
AU - Vleugels, Jasper L. A.
AU - Elkady, Soad
AU - Kabir, Misha
AU - Campbell, Samantha
AU - Kok, Klaartje
AU - Armstrong, David G.
AU - Penez, Lawrence
AU - Arenaza, Aitor P.
AU - Seward, Edward
AU - Vega, Roser
AU - Mehta, Shameer
AU - Rahman, Farooq
AU - McCartney, Sara
AU - Bloom, Stuart
AU - Patel, Kamal
AU - Pollok, Richard
AU - Westcott, Edward
AU - Darakhshan, Amir
AU - Williams, Andrew
AU - Koumoutsos, Ioannis
AU - Ray, Shuvra
AU - Mawdsley, Joel
AU - Anderson, Simon
AU - Sanderson, Jeremy D.
AU - Dekker, Evelien
AU - D'Haens, Geert R.
AU - Hart, Ailsa
AU - Irving, Peter M.
N1 - Copyright © 2018 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: [email protected].
PY - 2019/5/27
Y1 - 2019/5/27
N2 - BACKGROUND AND AIMS: There are no universally accepted guidelines regarding surveillance of ulcerative colitis [UC] patients after restorative proctocolectomy and ileal pouch-anal anastomosis [IPAA]. There also exists a lack of validated quality assurance standards for performing pouchoscopy. To better understand IPAA surveillance practices in the face of this clinical equipoise, we carried out a retrospective cohort study at five inflammatory bowel disease [IBD] referral centres. METHODS: Records of patients who underwent IPAA for UC or IBD unclassified [IBDU] were reviewed, and patients with <1-year follow-up after restoration of intestinal continuity were excluded. Criteria for determining the risk of pouch dysplasia formation were collected as well as the use of pouchoscopy, biopsies, and completeness of reports. RESULTS: We included 272 patients. Median duration of pouch follow-up was 10.5 [3.3-23.6] years; 95/272 [35%] had never undergone pouchoscopy for any indication; 191/272 [70%] had never undergone pouchoscopy with surveillance as the specific indication; and 3/26 [12%] high-risk patients had never undergone pouchoscopy. Two cases of adenocarcinoma were identified, occurring in the rectal cuff of low-risk patients. Patients under the care of surgeons appeared more likely to undergo surveillance, but rates of incomplete reporting were higher among surgeons [78%] than gastroenterologists [54%, p = 0.002]. CONCLUSIONS: We observed wide variation in surveillance of UC/IBDU-IPAA patients. In addition, the rate of neoplasia formation among 'low-risk' patients was higher than may have been expected. We therefore concur with previous recommendations that pouchoscopy be performed at 1 year postoperatively, to refine risk-stratification based on clinical factors alone. Reports should document findings in all regions of the pouch and biopsies should be taken.
AB - BACKGROUND AND AIMS: There are no universally accepted guidelines regarding surveillance of ulcerative colitis [UC] patients after restorative proctocolectomy and ileal pouch-anal anastomosis [IPAA]. There also exists a lack of validated quality assurance standards for performing pouchoscopy. To better understand IPAA surveillance practices in the face of this clinical equipoise, we carried out a retrospective cohort study at five inflammatory bowel disease [IBD] referral centres. METHODS: Records of patients who underwent IPAA for UC or IBD unclassified [IBDU] were reviewed, and patients with <1-year follow-up after restoration of intestinal continuity were excluded. Criteria for determining the risk of pouch dysplasia formation were collected as well as the use of pouchoscopy, biopsies, and completeness of reports. RESULTS: We included 272 patients. Median duration of pouch follow-up was 10.5 [3.3-23.6] years; 95/272 [35%] had never undergone pouchoscopy for any indication; 191/272 [70%] had never undergone pouchoscopy with surveillance as the specific indication; and 3/26 [12%] high-risk patients had never undergone pouchoscopy. Two cases of adenocarcinoma were identified, occurring in the rectal cuff of low-risk patients. Patients under the care of surgeons appeared more likely to undergo surveillance, but rates of incomplete reporting were higher among surgeons [78%] than gastroenterologists [54%, p = 0.002]. CONCLUSIONS: We observed wide variation in surveillance of UC/IBDU-IPAA patients. In addition, the rate of neoplasia formation among 'low-risk' patients was higher than may have been expected. We therefore concur with previous recommendations that pouchoscopy be performed at 1 year postoperatively, to refine risk-stratification based on clinical factors alone. Reports should document findings in all regions of the pouch and biopsies should be taken.
KW - Colitis, Ulcerative/diagnosis
KW - Endoscopy, Gastrointestinal
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Pouchitis/diagnosis
KW - Proctocolectomy, Restorative
KW - Retrospective Studies
UR - https://www.scopus.com/pages/publications/85066942282
UR - https://www.ncbi.nlm.nih.gov/pubmed/30590513
U2 - 10.1093/ecco-jcc/jjy225
DO - 10.1093/ecco-jcc/jjy225
M3 - Article
C2 - 30590513
SN - 1873-9946
VL - 13
SP - 735
EP - 743
JO - Journal of Crohn s & colitis
JF - Journal of Crohn s & colitis
IS - 6
ER -