Management of pouch neoplasia: consensus guidelines from the International Ileal Pouch Consortium.

Surveillance pouchoscopy is recommended for patients with restorative proctocolectomy with ileal pouch-anal anastomosis in ulcerative colitis or familial adenomatous polyposis, with the surveillance interval depending on the risk of neoplasia. Neoplasia in patients with ileal pouches mainly have a glandular source and less often are of squamous cell origin. Various grades of neoplasia can occur in the prepouch ileum, pouch body, rectal cuff, anal transition zone, anus, or perianal skin. The main treatment modalities are endoscopic polypectomy, endoscopic ablation, endoscopic mucosal resection, endoscopic submucosal dissection, surgical local excision, surgical circumferential resection and re-anastomosis, and pouch excision. The choice of the treatment modality is determined by the grade, location, size, and features of neoplastic lesions, along with patients' risk of neoplasia and comorbidities, and local endoscopic and surgical expertise.

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Declaration of interests CNB reports grants and personal fees from AbbVie, Janssen Canada, Pfizer, and Takeda Canada; and personal fees from Roche Canada, Bristol-Myers-Squibb Canada, Sandoz Canada, Mylan Pharmaceuticals, Takeda, and Medtronics Canada. DHB reports grants from Nextrast, Medtronic, and Takeda. WB reports consultant or speaker fees from Takeda, Braun, Johnson & Johnson, and Medtronic; and grants from VIFOR. RKC reports personal fees from AbbVie, Bristol Myers Squibb, Eli Lilly Janssen, Pfizer, Samsung Bioepis, and Takeda. SC reports personal fees from Pfizer and AbbVie. FAF reports personal fees from Arena, BMS, Braintree Labs, GI Reviewers, GSK, Innovation Pharmaceuticals, Iterative scopes, Janssen, Pfizer, and Sebela; and a data safety monitoring board role at Lilly and TheraVance. LAK reports personal fees from UpToDate and New Beta Innovation and grants from Varian Medical Systems. SE-H reports speaker fees from AbbVie, Bristol Myers Squibb, Janssen, Takeda, and Pfizer; and advisory board role at AbbVie, Prometheus, Bristol Myers, and UCB. SVK reports personal fees from Pfizer and grants from Gilead Sciences and TechLab. PGK reports personal fees from AbbVie, Janssen, Pfizer, Takeda, and Ferring; and grants from Pfizer and Takeda. GSK reports consulting fees from Janssen, Bristol Meyers Squibb, United Healthcare, Spherix Health, and TechLab; and an editor role at UpToDate. JTM reports personal fees from Intuitive Surgical. XL reports personal fees AbbVie, Arrowhead Pharmaceuticals, and PathAI. UN reports grants and personal fees from Takeda, Janssen, and AbbVie; and personal fees from Pfizer. DSP reports research grants from Atlantic, Finch, Janssen, Pfizer, Seres, Takeda, Vedanta, and Applied Molecular Transport; and consulting fees from Vedanta, Seres, and Otsuka. JP reports speaker fees from AbbVie. DKR reports consulting fees from Olympus, Boston Scientific, Arles Pharmaceutical, Braintree Laboratories, Lumendi, Norgine, Endokey, and GU supplies; and research support from Olympus and Braintree Laboratories. DTR reports personal fees from AbbVie, Altrubio, Allergan, Arena Pharmaceuticals, Bellatrix Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Celgene Corp–Syneos, Connect BioPharma, GalenPharma–Atlantica, Genentech–Roche, Gilead Sciences, InDex Pharmaceuticals, Ironwood Pharmaceuticals, Iterative Scopes, Janssen Pharmaceuticals, Lilly, Materia Prima, Pfizer, Prometheus Biosciences, Reistone, Takeda, and TechLab. AS reports consulting fees from Takeda, Ethicon, Pfizer, and Oasis. BS reports personal fees from AbbVie, Janssen, and Takeda. ES reports grants and personal fees from AbbVie, Janssen, Takeda; and grants from Astra-Zeneca, Pfizer, and Genentech; and personal fees from Seres Health, Protagonist Therapeutics, Celgene, Entera Health, Bristol Myers Squibb, and Evidera. RAS reports personal fees from Merck & Co. WJS reports personal fees from AbbVie, Takeda, UCB, Janssen, Gilead, Pfizer, and Tract. WJS reports grants, personal fees, and stock or stock options from Prometheus Biosciences; grants and personal fees from AbbVie, Abivax, Alimentiv, Arena Pharmaceuticals, Boehringer-Ingelheim, Celgene, Genentech (Roche), Gilead Sciences, Glaxo Smith Kline, Janssen, Lilly, Pfizer, Prometheus Biosciences, Seres Therapeutics, Shire, Surrozen, Takeda, and Theravance Biopharma; personal fees and stock or stock options from Beigene, Gossamer Bio, and Shoreline Bioscience; and personal fees from Allergan, Amgen, Applied Molecular Transport, Avexegen Therapeutics, Bausch Health (Salix), Beigene, Bellatrix Pharmaceuticals, Boston Pharmaceuticals, Bristol Myers Squibb, Celltrion, Cellularity, Conatus, Cosmo Pharmaceuticals, Escalier Biosciences, Ferring, Forbion, Equillium, Glanmark Pharmaceuticals, Immunic (Vital Therapies), Incyte, Index Pharmaceuticals, Intact Therapeutics, Kyowa Kirin Pharmaceutical Research, Kyverna Therapeutics, Landos Biopharma, Miraca Life Sciences, Nivalis Therapeutics, Novartis, Nutrition Science Partners, Oppilan Pharma, Progenity, Protagonist Therapeutics, Provention Bio, Reistone Biopharma, Ritter Pharmaceuticals, Shanghai Pharma Biotherapeutics, Sienna Biopharmaceuticals, Sigmoid Biotechnologies, Sterna Biologicals, Sublimity Therapeutics, and Thetis Pharmaceuticals. All other authors declare no competing interests.