Pouchoscopy

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

Dysplasia and Cancer in the Ileal Pouch

Abstract: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) greatly reduces the risk of colitis-associated neoplasia. However, the surgical procedure does not complete abolish the risk of cancer. Dysplasia or cancer of IPAA can occur, which, if present, is predominantly located in the anal transitional zone or rectal cuff. Mucosectomy has not been shown to be completely eradicate the risk for pouch neoplasia. Pouchoscopy with biopsy is currently the gold standard modality for surveillance. However, regular pouchoscopy with surveillance may still miss dysplasia. The strongest risk factor for pouch neoplasia is the presence of colitis-associated neoplasia of the large bowel before colectomy. Other purported risk factors including chronic pouchitis and cuffitis, long duration of disease, and the presence of primary sclerosing cholangitis or family history of colorectal cancer. This author recommends that yearly surveillance pouchoscopy be performed in the patients at risk and pouchoscopy every 2–3 years in those without those risk factors.

PTH-118 Mucosal tissue short chain fatty acids contribute to prediction of pouchitis in restorative proctocolectomy

Abstract: Background Restorative proctocolectomy is a surgical option in patients with ulcerative colitis who become refractory to medical therapy. Short chain fatty acids (SCFA) are organic fatty acids with 1–6 carbons which arise from bacterial metabolism from carbohydrates entering the colon. Various studies have implicated SCFA in both the development of IBD and flares of IBD. Furthermore, it has been shown that SCFA concentrations are significantly lower in faecal samples from patients with pouchitis when compared with healthy controls. Our study aimed to assess longitudinal changes in SCFA that occur in a pouch to determine if they can predict or are associated with the development of pouchitis. To date no study has analysed short chain fatty acids in mucosal biopsy tissue from these patients. Methods Patients who underwent restorative proctocolectomy at a single centre underwent pouchoscopy at the time of restoration of continuity and then every 6 months for a year. Biopsies from the pouch were retrieved from the pouch body. Pouchitis was defined using the pouch disease activity index. The development of pouchitis was assessed at months 6 and 12 months. Biopsies samples were snap frozen at time of biopsy and stored in -80°C. Samples were thawed and weighed. Sterile water and Methyl tertiary-butyl ether with internal standard (IS) were added with a ratio of 20 mg of sample:50µL of H20:250µL of MTBE and IS with a further 4µL of hydrochloric acid added to each sample. 30µL of the polar phase was then placed into silanized Eppendorf tubes. 150µL of derivatiser was added to each sample and the cap of the tube applied immediately. These were then incubated for 45 minutes at 60°C in an oven. 70µL from the silanised vial was placed into vial inserts and analysed in the gas chromatography mass spectrometry machine. (GC-MS). SCFA were measured using an Agilent 7000C Triple Quadrupole GC/MS-MS System according to a previously published method. Simca was used for multivariate analysis and T-tests were used for univariate analysis. Results There were 56 biopsy samples. There were 22 patients (17 males); 16 UC and 6 FAP patients with longitudinal follow up. The median age of the cohort was 40 years (range 20–60 years). Of the UC patients four developed pouchitis within one year. When comparing UC patients at the time of closure of ileostomy, there were there were significant decreases in caproic acid (4674µM vs 12217µM p Conclusion The study has suggested that a decrease in SCFA found in the mucosal tissue at time of closure of ileostomy may predict onset of pouchitis within a year. This study is the first to demonstrate that SCFA can be analysed from biopsies. Future studies need to determine factors that may contribute to tissue SCFA levels which may help develop a potential therapeutic target to optimise and potentially reduce the incidence of pouchitis.

Endoscopy in Crohn’s disease of the pouch

Abstract: Restorative proctocolectomy with ileal pouch-anal anastomosis is the standard surgical treatment modality for ulcerative colitis patients who require colectomy. While the surgical procedure improves health-related quality of life in patients with refractory colitis, it is associated with an array of mechanical, inflammatory, and functional disorders of the pouch. Crohn’s disease of the pouch is one of the most serious inflammatory complications. The majority of those patients develop the disease after surgery (de novo Crohn’s disease). Crohn’s disease of the pouch can be classified into inflammatory, stricturing, and fistulizing phenotypes. Pouchoscopy plays a key role in the diagnosis, differential diagnosis, and therapy for Crohn’s disease of the pouch.

Functional outcome and patient satisfaction after ileal pouch anal anastomosis for ulcerative colitis in a developing country.

Abstract: AIM To study the long-term outcome and patient satisfaction of patients with an ileal pouch-anal anastomosis (IPAA) for ulcerative colitis in India. PATIENTS AND METHODS We studied 35 patients who had undergone IPAA for ulcerative colitis between 1985 and 1998 and had intestinal continuity restored for more than 6 months. These patients were asked to answer a detailed questionnaire on their bowel function, urogenital function, etc. A complete haemogram, serum iron studies, liver function tests and D-Xylose absorption test were done. In addition hepatobiliary ultrasound, stool microscopy, pouchoscopy and pouch biopsies were also performed. Patient satisfaction after the procedure was also evaluated. RESULTS Thirty-five patients (17 men and 18 women) underwent a complete evaluation. The duration after restoration of continuity ranged from 6 months to 164 months (mean 78.6 months). The mean stool frequency was 7.2 stools per 24 hours. Five patients had urgency of stool, 9 had occasional soiling and 1 had major incontinence. Four patients had minimal restriction of social activities and 1 discontinued his employment. All patients were sexually satisfied except one man who had impotence and one woman who had dyspareunia. Fifteen patients had abnormal serum iron studies (Haemoglobin < 9 g/dl in 11). Eleven patients had D-Xylose absorption below normal values. Two patients were found to have gallstones. All pouch biopsies showed chronic inflammation and 1 patient had histological evidence of pouchitis. Eighty-five percent of patients reported that they were very satisfied with the procedure. CONCLUSION Good functional recovery and acceptance of the procedure over the long term suggests that it is a valid procedure to be recommended for patients with ulcerative colitis in India.

Neoterminal Ileal Polyposis and Ulceration after Restorative Proctocolectomy with a Current Review of the Literature.

Abstract: After ileal pouch anal anastomosis, one of the frequently encountered complications is polyposis of the pouch. We describe a case of proximal neoterminal ileal polyposis associated with deep ulceration suggestive of Crohn's disease and review the available literature. A 36-year-old male presented with resistant pouchitis 11 years after surgery for ulcerative colitis. With all-negative initial workup, pouchoscopy showed multiple deep ulcers in the proximal ileum with some polyps. Biopsy of polyps showed inflammatory polyps with negative immunohistological staining for IgG pouchitis. With no treatable etiology for pouchitis and the presence of inflammatory polyps, there are no guidelines for surveillance of this condition. Definitive diagnosis is challenging and there is no consensus or recommended guidelines on the management.