Showing papers on "Pouchoscopy published in 2008"

Familial adenomatous polyposis and the small bowel: A loco-regional review and current management strategies

Abstract: Small-bowel tumours are an important cause of morbidity and death in patients with familial adenomatous polyposis. Intensive endoscopic surveillance is now standard in the long-term management of this condition. Thus, lesions occurring throughout the small bowel are increasingly noted by oesophagogastroduodenoscopy and flexible pouchoscopy. Some occur commonly de novo (in stomach, duodenum and ampulla), while others may occur following surgery (polyps of the ileostomy, ileoanal pouch, or small bowel above an anastomosis). These differ widely in incidence, natural history and management. This review provides a regional overview of these lesions, in terms of current research findings and management protocols.

Assessment of the mucosa of the indefinitely diverted ileo-anal pouch.

Abstract: Objective One surgical option to treat failure afterrestorative proctocolectomy (RPC) is indefinite diversion(ID) without excision of the pouch. The study aimed toassess the mucosal morphology of the pouch and ileoanalanastomosis (IAA) over time after ID with particularreference to inflammation, dysplasia and carcinoma.Method Patients with ID were identified from thehospital’s Ileal Pouch Database. Individuals were invitedby mail to attend for flexible pouchoscopy and biopsyfrom the ileal pouch and immediately distal to the IAA.Results Of 1822 patients on the database, 28 hadundergone ID. Of these, 20 patients (18 ulcerativecolitis, one familial adenomatous polyposis, one pseudo-obstruction) of median age 42 (18–67) years took part.There were eight males. The median (range) intervalsfrom diagnosis of primary disease, pouch surgery and IDto the time of study were 221 (63–410), 146 (31–314)and 44 (10–159) months respectively. One patient haddysplasia in the original resection specimen. Five patientsdeveloped type C changes in the pouch. Of these threewere identified between RPC and ID, one developedbetween ID and the present assessment and one wasidentified for the first time at the present assessment. Nocase of dysplasia or cancer was found in any of thebiopsies. Rectal mucosa was found in biopsies from theIAA in four patients (three stapled; one handsewn); thiswas inflamed in three patients.Conclusion At a median follow-up of 12 years after RPCand 3.6 years after indefinite diversion no instance ofdysplasia or carcinoma in the ileal reservoir or distal to theIAA was found in any of the 20 patients having ID. TypeC changes occurred at some time in five (25%) patients,indicating the importance of continued follow up.Keywords Restorative proctocolectomy, ileal pouch analanastomosis, ileal reservoir, ulcerative colitis, familialadenomatous polyposis, dysplasia