Showing papers on "Pouchoscopy published in 2021"
TL;DR: In this article, the reliability and accuracy of new endoscopic items for pouchitis and of the Ulcerative Colitis Endoscopic Index of Severity (UCIS) for cuffitis were assessed and included in the Monash pouchitis endoscopic subscore.
Abstract: Background and aims Currently-used endoscopic items for the assessment of pouchitis and cuffitis have deficiencies in reliability and validation. We assessed the reliability and accuracy of new endoscopic items for pouchitis and of the Ulcerative Colitis Endoscopic Index of Severity (UCIS) for cuffitis. Methods Three new endoscopic items were assessed and included in the Monash pouchitis endoscopic subscore: bleeding (absent/contact/spontaneous); erosions (absent/ Results All three Monash endoscopic items had substantial intra-rater reliability with an intraclass correlation coefficients (ICCs) > 0.61(95% CI >0.61), compared with only ulcers from the currently-used PDAI endoscopic subscore, but inter-rater reliability was only substantial for ulceration and no better than those of the currently-used endoscopic items. The Monash endoscopic subscore had a strong positive correlation with the reference standard global endoscopic lesion severity r=0.80 (95% CI 0.80-0.80) and the reference standard PDAI endoscopic subscore r=0.70 (95% CI 0.67-0.73), which was higher than the correlation observed for the currently-used PDAI endoscopic subscore. The UCEIS had substantial intra-rater reliability, but only fair inter-rater reliability and poor diagnostic performance for cuffitis. Conclusion The Monash endoscopic items and endoscopic subscore they generate have enhanced overall performance compared with the currently-used PDAI items and subscore. Further validation and responsiveness to change in disease state are indicated.
3 citations
TL;DR: HSI values of perfusion and oxygenation of the IPAA were high and the leak rate is associated with redo procedures, reflected by the current literature and most likely related to the higher complexity of the revisional pouch operation.
Abstract: Introduction Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a challenging operation. Especially the mobilization of the pouch into the pelvis can be complex. Adequate perfusion of the pouch is required for optimal healing and functioning. Methods With hyperspectral imaging (HSI) wavelengths between 500 and 1,000 nm can be analyzed in addition to visible light and by reflecting patterns. This intraoperative procedure is non-invasive, contact-free, and no contrast medium is needed. Fifteen patients undergoing IPAA were examined prospectively, and the pouch was evaluated by HSI intraoperatively. HSI was measured in standardized fashion at 4 defined locations of the J-pouch. Each measurement took about 10 s. The clinical postoperative course was assessed in all patients and correlated to the intraoperative HSI findings. Results Mean near-infrared perfusion and oxygenation of patients showed values ≥74% for all defined pouch areas, revealing good blood supply. Three minor anastomotic leaks were detected by standard pouchoscopy in the postoperative course, which could be treated conservatively with endosponge therapy. Conclusion HSI values of perfusion and oxygenation of the IPAA were high. The leak rate is associated with redo procedures. This is reflected by the current literature and most likely related to the higher complexity of the revisional pouch operation. HSI has proved itself as a quick and effective new intraoperative tool to evaluate pouch perfusion objectively and quantitatively.
2 citations
TL;DR: In this paper, a 36-year-old man with familial adenomatous polyposis secondary to an adeno-polyposis coli mutation status post proctocolectomy with ileal pouch-anal anastomosis presented with hematochezia.
Abstract: A 36-year-old man with familial adenomatous polyposis secondary to an adenomatous polyposis coli mutation status post proctocolectomy with ileal pouch-anal anastomosis presented with hematochezia. Pouchoscopy revealed a 4-cm indurated mass in the distal ileal pouch just 17 months after a normal pouchoscopy. Histopathology was diagnostic for Burkitt lymphoma, and the patient achieved complete remission with subsequent chemotherapy. Although there are reports of Burkitt lymphoma in patients with ileal pouch-anal anastomosis, to date, this is the first report in a patient with familial adenomatous polyposis. This case highlights the presentation of a rapidly enlarging tumor not commonly seen in the adult gastroenterology population.