Pouchoscopy

About: Pouchoscopy is a research topic. Over the lifetime, 99 publications have been published within this topic receiving 5745 citations.

Comparison of the Moskowitz criteria and the pouchitis disease activity index (PDAI) for diagnosis of ileoanal pouch inflammation.

Abstract: Objective To prospectively compare two indices for diagnosis of pouchitis: Moskowitz criteria and pouchitis disease activity index (PDAI). Patients and methods Fifty-six consecutive patients with an ileoanal pouch for ulcerative colitis were recruited. A clinical questionnaire was composed and the Oresland functional score calculated. Pouchoscopy and biopsy were performed after cleansing of the pouch. Results Seven patients had pouchitis according to both Moskowitz and PDAI (‘positive’ group). Five patients had PDAI ≥ 7, but did not fulfil the Moskowitz criteria (‘negative’ group). The pouchoscopy and Oresland functional scores were similar between the two groups. The biopsy neutrophilia and ulceration were more prominent in the ‘positive’ group (χ2=5.18, P < 0.05), whereas urgency (χ2=8.4, P < 0.001), evacuation difficulties (χ2=5.18, P < 0.05) and history of bleeding per pouch (χ2=4.18, P < 0.05) were more pronounced in the ‘negative’ group. Conclusion Moskowitz criteria may be broadly in agreement with the PDAI; these, however, cannot be regarded as interchangeable.

Incidence and Long-term Implications of Prepouch Ileitis: An Observational Study.

Abstract: Background Restorative proctocolectomy is the procedure of choice in patients with ulcerative colitis refractory to medical therapy. Prepouch ileitis is characterized by mucosal inflammation immediately proximal to the pouch. Prepouch ileitis is uncommon, and long-term follow-up data are lacking. Objective The aim of this study is to report the long-term outcomes of prepouch ileitis. Design We followed up a cohort of patients with prepouch ileitis that was originally described in 2009. Patients were followed up until the last recorded clinic attendance or at the point of pouch failure. Follow-up data collected included stool frequency, endoscopic findings, treatment, and overall pouch function. Setting We accessed a prospectively maintained database at our institution between January 2009 and January 2017. Patients Three of the 34 patients originally described in 2009 were lost to follow-up; we reanalyzed data on the remaining 31. Main outcome measure The rate of pouch failure was defined as the need for ileostomy or pouch revision. Results All 31 patients had coexisting pouchitis at index diagnosis of prepouch ileitis. The median length of follow-up from the index pouchoscopy was 98 (range, 27-143) months. Seven (23%) patients who had an index pouchoscopy with prepouch ileitis went on to pouch failure, which is significantly higher than expected (p = 0.03). Five (71%) of these patients had chronic pouchitis, and 2 (29%) had small-bowel obstruction due to prepouch stricture. Two patients had evidence that would support possible Crohn's disease at long-term follow-up. Limitations This was a retrospective analysis. Because of the nature of the study, there was some missing information that may have influenced the results. Our study is further limited by small patient numbers. Conclusions Prepouch ileitis is associated with a significantly increased risk of pouch failure compared with the overall reported literature for restorative proctocolectomy. Prepouch ileitis does not appear to be strongly predictive of Crohn's disease at long-term follow-up. See Video Abstract at http://links.lww.com/DCR/A480.

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

Octreotide for the treatment of diarrhoea in patients with ileal pouch anal anastomosis: a placebo-controlled crossover study.

Abstract: Aim Diarrhoea with urgency is a debilitating long-term complication of ileal pouch anal anastomosis (IPAA) after a proctocolectomy. Somatostatin analogues are used to control diarrhoea and high-output ostomies. Hence, we designed a prospective, double-blind, crossover trial to explore the efficacy and tolerability of octreotide to reduce diarrhoea in adult patients with IPAA. Method Patients were randomized to octreotide subcutaneously (SC), 500 μg three times daily (t.i.d.), or matching placebo SC for 7 days. Responders (a reduction in stool frequency of three or more stools per 24-h period and with a reduction in stool frequency of at least 30% after 7 days of treatment compared with baseline; the primary end-point) remained in the same group and nonresponders could cross over to the alternative treatment for 7 days. Open-label octeotide LAR 30 mg was offered to all responders on day 14. Flexible pouchoscopy with biopsies was performed at baseline in all patients and was repeated on days 7 and 14 in patients with pouchitis. Results Fifteen patients (11 men, median age 52 years), all with ulcerative colitis, were randomized. Three patients were withdrawn for side effects during the blinded phase. Response was achieved by two of 12 and two of 11 patients treated with octreotide or placebo, respectively (including crossover, P = 0.9). The median stool frequency remained stable in both groups [Δoctreotide: 0 (IQR, −4 to 0), Δplacebo: −1 (IQR, −1 to 1), P = 0.45]. Octreotide had no effect on the modified pouch disease activity index (mPDAI), and pouchitis persisted in five of six subjects with pouchitis at onset. One subject received open-label octreotide LAR. Conclusion Octreotide has no clear beneficial effect on the stool pattern or on pouchitis severity in patients with high stool frequency after IPAA.

Inflammation and Neoplasia of the Pouch in Inflammatory Bowel Disease.

Abstract: Ileal pouch-anal anastomosis (IPAA) is the standard restorative procedure after proctocolectomy in patients with inflammatory bowel disease who require colectomy. The ileal pouch is susceptible to a variety of adverse outcomes including mechanical insult, ischemia, and infectious agents. There is also a risk for developing low-grade dysplasia (LGD), high-grade dysplasia (HGD), or even adenocarcinoma in the pouch. The purpose of this review is to highlight risk factors, clinical presentation, surveillance, and treatment of pouch neoplasia. Patients with pre-colectomy colitis-associated neoplasia are at high risk for developing pouch neoplasia. Other purported risk factors include the presence of family history of colorectal cancer, the presence of concurrent primary sclerosing cholangitis, chronic pouchitis, cuffitis, or Crohn’s disease of the pouch. Pouch adenocarcinoma tends to have a poor prognosis. It is recommended to have a combined clinical, endoscopic, and histologic approach in diagnosis and management. Surveillance and management algorithms of pouch neoplasia are proposed, based on the risk stratification.