Diagnosis and Management of Cuffitis: A Systematic Review.
Journal
Diseases of the colon and rectum
ISSN: 1530-0358
Titre abrégé: Dis Colon Rectum
Pays: United States
ID NLM: 0372764
Informations de publication
Date de publication:
01 12 2022
01 12 2022
Historique:
entrez:
18
11
2022
pubmed:
19
11
2022
medline:
23
11
2022
Statut:
ppublish
Résumé
In patients with ulcerative colitis or familial adenomatous polyposis who develop neoplasia or fail medical therapy and require colectomy, restorative proctocolectomy with IPAA is often indicated. Although often well tolerated, IPAA can be complicated by cuffitis or inflammation of the remaining rectal cuff. Although much has been published on this subject, there is no clear and comprehensive synthesis of the literature regarding cuffitis. Our systematic literature review analyzes 34 articles to assess the frequency, cause, pathogenesis, diagnosis, classification, complications, and treatment of cuffitis. Cuffitis occurs in an estimated 10.2% to 30.1% of pouch patients. Purported risk factors include rectal cuff length >2 cm, pouch-rectal anastomosis, stapled anastomosis, J-pouch configuration, 2- or 3-stage IPAA, preoperative Clostridium difficile infection, toxic megacolon, fulminant colitis, preoperative biologic use, medically refractory disease, immunomodulator/steroids use within 3 months of surgery, extraintestinal manifestations of IBD, and BMI <18.5 kg/m2 at the time of colectomy. Adverse consequences associated with cuffitis include decreased quality-of-life scores, increased risk for pouchitis, pouch failure, pouch excision, and pouch neoplasia. Given the similarities between pouchitis and cuffitis, diagnosis and treatment of cuffitis should proceed according to the International Ileal Pouch Consortium guidelines. This review found that the majority of the current literature fails to distinguish between classic cuffitis (a form of reminant ulcerative proctitis) and nonclassic cuffitis (resulting from other causes). Further work is needed to distinguish the unique risk factors and endoscopic characteristics associated with each subtype, and further randomized clinical trials should be conducted to strengthen the evidence for treatment options.
Sections du résumé
BACKGROUND
In patients with ulcerative colitis or familial adenomatous polyposis who develop neoplasia or fail medical therapy and require colectomy, restorative proctocolectomy with IPAA is often indicated. Although often well tolerated, IPAA can be complicated by cuffitis or inflammation of the remaining rectal cuff. Although much has been published on this subject, there is no clear and comprehensive synthesis of the literature regarding cuffitis.
METHODS
Our systematic literature review analyzes 34 articles to assess the frequency, cause, pathogenesis, diagnosis, classification, complications, and treatment of cuffitis.
RESULTS
Cuffitis occurs in an estimated 10.2% to 30.1% of pouch patients. Purported risk factors include rectal cuff length >2 cm, pouch-rectal anastomosis, stapled anastomosis, J-pouch configuration, 2- or 3-stage IPAA, preoperative Clostridium difficile infection, toxic megacolon, fulminant colitis, preoperative biologic use, medically refractory disease, immunomodulator/steroids use within 3 months of surgery, extraintestinal manifestations of IBD, and BMI <18.5 kg/m2 at the time of colectomy. Adverse consequences associated with cuffitis include decreased quality-of-life scores, increased risk for pouchitis, pouch failure, pouch excision, and pouch neoplasia.
CONCLUSIONS
Given the similarities between pouchitis and cuffitis, diagnosis and treatment of cuffitis should proceed according to the International Ileal Pouch Consortium guidelines. This review found that the majority of the current literature fails to distinguish between classic cuffitis (a form of reminant ulcerative proctitis) and nonclassic cuffitis (resulting from other causes). Further work is needed to distinguish the unique risk factors and endoscopic characteristics associated with each subtype, and further randomized clinical trials should be conducted to strengthen the evidence for treatment options.
Identifiants
pubmed: 36399769
doi: 10.1097/DCR.0000000000002593
pii: 00003453-202212001-00012
doi:
Types de publication
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
S85-S91Informations de copyright
Copyright © The ASCRS 2022.
Références
Shen B, Kochhar GS, Rubin DT, et al. Treatment of pouchitis, Crohn’s disease, cuffitis, and other inflammatory disorders of the pouch: consensus guidelines from the International Ileal Pouch Consortium. Lancet Gastroenterol Hepatol. 2022;7:69–95.
Wu B, Lian L, Li Y, et al. Clinical course of cuffitis in ulcerative colitis patients with restorative proctocolectomy and ileal pouch-anal anastomoses. Inflamm Bowel Dis. 2013;19:404–410.
Kayal M, Plietz M, Rizvi A, et al. Inflammatory pouch conditions are common after ileal pouch anal anastomosis in ulcerative colitis patients. Inflamm Bowel Dis. 2020;26:1079–1086.
Shen B, Fazio VW, Remzi FH, et al. Comprehensive evaluation of inflammatory and noninflammatory sequelae of ileal pouch-anal anastomoses. Am J Gastroenterol. 2005;100:93–101.
Lavery IC, Sirimarco MT, Ziv Y, Fazio VW. Anal canal inflammation after ileal pouch-anal anastomosis. The need for treatment. Dis Colon Rectum. 1995;38:803–806.
Thompson-Fawcett MW, Mortensen NJ, Warren BF. “Cuffitis” and inflammatory changes in the columnar cuff, anal transitional zone, and ileal reservoir after stapled pouch-anal anastomosis. Dis Colon Rectum. 1999;42:348–355.
Makkar R, Graff LA, Bharadwaj S, Lopez R, Shen B. Psychological factors in irritable pouch syndrome and other pouch disorders. Inflamm Bowel Dis. 2015;21:2815–2824.
Litzendorf ME, Stucchi AF, Wishnia S, Lightner A, Becker JM. Completion mucosectomy for retained rectal mucosa following restorative proctocolectomy with double-stapled ileal pouch-anal anastomosis. J Gastrointest Surg. 2010;14:562–569.
Lovegrove RE, Constantinides VA, Heriot AG, et al. A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients. Ann Surg. 2006;244:18–26.
O’Connell PR, Pemberton JH, Weiland LH, et al. Does rectal mucosa regenerate after ileoanal anastomosis? Dis Colon Rectum. 1987;30:1–5.
Shen B, Fazio VW, Remzi FH, Lashner BA. Clinical approach to diseases of ileal pouch-anal anastomosis. Am J Gastroenterol. 2005;100:2796–2807.
Tonelli F, Giudici F, Di Martino C, Scaringi S, Ficari F, Addasi R. Outcome after ileal pouch-anal anastomosis in ulcerative colitis patients: experience during a 27-year period. ANZ J Surg. 2016;86:768–772.
Shen B, Kochhar GS, Kariv R, et al. Diagnosis and classification of ileal pouch disorders: consensus guidelines from the International Ileal Pouch Consortium. Lancet Gastroenterol Hepatol. 2021;6:826–849.
Shen B, Liu X. De novo collagenous cuffitis. Inflamm Bowel Dis. 2011;17:1249–1250.
Akiyama S, Ollech JE, Rai V, et al. Endoscopic phenotype of the J pouch in patients with inflammatory bowel disease: a new classification for pouch outcomes. Clin Gastroenterol Hepatol. 2022;20:293–302.e9.
Shen B, Lashner BA, Bennett AE, et al. Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis. Am J Gastroenterol. 2004;99:1527–1531.
Parsi MA, Shen B, Achkar JP, et al. Fecal lactoferrin for diagnosis of symptomatic patients with ileal pouch-anal anastomosis. Gastroenterology. 2004;126:1280–1286.
Ardalan ZS, Con D, Chandran S, et al. The reliability and accuracy of endoscopic items and scores used in the assessment of the ileoanal pouch and cuff. J Crohns Colitis. 2022;16:18–26.
Groisman G, Cai Z, Sabo E, Harpaz N. SATB2 and Hep Par 1 immunohistochemistry is helpful in distinguishing between inflamed and architecturally altered ileal pouch and rectal cuff mucosa. Int J Surg Pathol. 2019;27:159–165.
Shen B, Achkar JP, Lashner BA, et al. Endoscopic and histologic evaluation together with symptom assessment are required to diagnose pouchitis. Gastroenterology. 2001;121:261–267.
Sandborn WJ, Tremaine WJ, Batts KP, Pemberton JH, phillips SF. Pouchitis after ileal pouch-anal anastomosis: a pouchitis disease activity index. Mayo Clin Proc. 1994;69:409–415.
Wu XR, Kiran RP, Mukewar S, Remzi FH, Shen B. Diagnosis and management of pouch outlet obstruction caused by common anatomical problems after restorative proctocolectomy. J Crohns Colitis. 2014;8:270–275.
Hashimoto T, Itabashi M, Ogawa S, et al. Treatment strategy for preventing pouchitis as a postoperative complication of ulcerative colitis: the significance of the management of cuffitis. Surg Today. 2014;44:1730–1734.
Elder K, Lopez R, Kiran RP, Remzi FH, Shen B. Endoscopic features associated with ileal pouch failure. Inflamm Bowel Dis. 2013;19:1202–1209.
Akiyama S, Ollech JE, Traboulsi C, et al. Histopathology of colectomy specimens predicts endoscopic pouch phenotype in patients with ulcerative colitis. Dig Dis Sci. 2022;67:4020–4031.
Khan F, Shen B. Inflammation and Neoplasia of the pouch in inflammatory bowel disease. Curr Gastroenterol Rep. 2019;21:10.
Al-Sukhni W, McLeod RS, MacRae H, O’Connor B, Huang H, Cohen Z. Oncologic outcome in patients with ulcerative colitis associated with dyplasia or cancer who underwent stapled or handsewn ileal pouch-anal anastomosis. Dis Colon Rectum. 2010;53:1495–1500.
Rabbenou W, Chang S. Medical treatment of pouchitis: a guide for the clinician. Therap Adv Gastroenterol. 2021;14:17562848211023376.
Shen B. Diagnosis and management of postoperative ileal pouch disorders. Clin Colon Rectal Surg. 2010;23:259–268.
Hasan B, Yim Y, Ur Rashid M, et al. Hyperbaric oxygen therapy in chronic inflammatory conditions of the pouch. Inflamm Bowel Dis. 2021;27:965–970.
Fahad H, Dulai PS, Shen B, Kochhar GS. Hyperbaric oxygen therapy is effective in the treatment of inflammatory and fistulizing pouch complications. Clin Gastroenterol Hepatol. 2021;19:1288–1291.
Serrero M, Santoni A, Grimaud JC, Desjeux A, Gonzalez JM, Barthet M. Cuffitis: is an endoscopic approach possible? Endosc Int Open. 2020;8:E544–E547.
Wu B, Liu X, Shen B. Refractory cuffitis resolved after temporary ileostomy and lysis of adhesion surgery. Inflamm Bowel Dis. 2013;19:E32–E33.
Fazio VW, Tjandra JJ. Transanal mucosectomy. Ileal pouch advancement for anorectal dysplasia or inflammation after restorative proctocolectomy. Dis Colon Rectum. 1994;37:1008–1011.