Showing papers on "Pouchoscopy published in 2009"

Guide to endoscopy of the ileo-anal pouch following restorative proctocolectomy with ileal pouch-anal anastomosis; indications, technique, and management of common findings.

Abstract: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis is the surgical procedure of choice for patients with ulcerative colitis (UC). It is also performed in selected patients with familial adenomatous polyposis (FAP). A significant proportion of patients will develop pouch dysfunction. Flexible pouchoscopy is the most important initial investigation in patients with dysfunction. It is also important in UC and FAP surveillance. The aim is to provide gastroenterologists with a clear understanding of the technique, indications, and diagnostic pitfalls when investigating RPC patients with flexible pouchoscopy. Flexible pouchoscopy for the investigation of RPC patients with pouch dysfunction has a high diagnostic yield, with most causes of pouch dysfunction identifiable during this procedure. The risk of developing dysplasia following RPC is low. Surveillance pouchoscopy is only recommended in those with FAP, those with a previous history of dysplasia or carcinoma, primary sclerosing cholangitis, those with a retained rectal cuff, and those with Type C histological changes. Flexible pouchoscopy is a useful first-line investigation in patients with pouch dysfunction. It can be performed without sedation and has a high diagnostic yield; it is also important as part of surveillance in FAP and selected UC patients.

Incidence and short-term implications of prepouch ileitis following restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis.

Abstract: Purpose Pouchitis following restorative proctocolectomy is common. Inflammation proximal to the pouch, prepouch ileitis (PPI) has recently been described. Its incidence and implications are unknown. The aim of this study was to identify the incidence of PPI at pouchoscopy and correlate this with symptoms, diagnosis, and outcome. Methods The authors searched the endoscopy database at our institution for the terms "pouchitis" and "ileitis" and reviewed hospital records. Results A total of 1448 pouchoscopies were performed on 742 patients. PPI was diagnosed in 34 (5.7 percent) patients with ulcerative colitis/indeterminate colitis and 1 (0.6 percent) with polyposis. All of the patients had concurrent pouch inflammation, and in this group the incidence was 13 percent. The median length of the PPI was 10 cm. Asymptomatic patients totaled 26 percent. At follow-up (median, 12 months) no patient was reclassified to Crohn's disease, and no patients required an ileostomy for poor function. Conclusions The incidence of PPI in patients with ulcerative colitis/indeterminate colitis is 5.7 percent, and it occurs in 13 percent of patients with pouch inflammation. All of the patients had associated pouch inflammation; however, not all of the patients were symptomatic. Our results demonstrate that PPI is common in patients with pouchitis; it does not imply missed Crohn's disease or predict an increased rate of pouch failure, at least in the short term.

An open study of antibiotics for the treatment of pre‐pouch ileitis following restorative proctocolectomy with ileal pouch–anal anastomosis

Abstract: Summary Background Pre-pouch ileitis is a recently described condition which may occur following restorative proctocolectomy. Its aetiology remains unknown and only one study has reported the effect of treatment. We report a series of fourteen patients treated and followed up with repeat pouchoscopy. Aim To study the effectiveness of antibiotics for the treatment of pre-pouch ileitis following restorative proctocolectomy with ileal pouch–anal anastomosis. Methods Fourteen consecutive patients with symptomatic pre-pouch ileitis were treated with ciprofloxacin 500 mg b.d. and metronidazole 400 mg b.d. for 28 days. All had concurrent pouchitis. Symptomatic, endoscopic and histological assessment was performed before and following treatment using the pouchitis disease activity index (PDAI). Symptomatic remission was defined as a score of 0 in the clinical component of the PDAI. Results Twelve (86%) patients experienced symptomatic remission. Stool frequency fell from a median of 12 (range 8–20) to 6 (4–17) (P = 0.002). There was a significant reduction in the anatomical length of pre-pouch ileitis with nine (64%) patients having either a resolution or a reduction in length of pre-pouch ileitis from a median of 10 cm (range 3–20 cm) to a median of 1 cm (range 0–10 cm) (P = 0.007). Conclusion Combination antibiotic therapy in this uncontrolled study appears effective in reducing the length of pre-pouch ileitis and in inducing symptomatic remission in most patients whether or not its extent is reduced.

Endoscopically assisted transanal division of pouch septum after ileal pouch-anal anastomosis for ulcerative colitis

Abstract: Prior to diverting loop ileostomy reversal in a 49-year-old man with ulcerative colitis and an ileal pouch–anal anastomosis, a pouchogram revealed a filling defect in the mid portion of the pouch (1). Pouchoscopy confirmed a 4-cm mucosal pouch septum (2). Under colonoscopic visualization via the defunctionalized limb of the loop ileostomy, the septum was divided transanally using a laparoscopic stapler (3). A postprocedure pouchogram demonstrated normal pouch anatomy (4). Uneventful take-down of the ileostomy was performed 3 months later. 1 Pouchogram, demonstrating a filling defect. 2 Pouchoscopy. Photograph of pouch septum. 3 Illustration of the pouch septum (A); transanal division of the pouch septum using an Endo-GIA stapler under colonoscopic visualization (B); resultant anatomy (C). 4 Pouchogram (postprocedure) demonstrating the resultant normal pouch anatomy 1