Can preoperative CT/MR enterography preclude the development of Crohn's disease-like pouch complications in ulcerative colitis patients undergoing J pouch surgery?
CT enterography
Crohn's disease-like pouch complications
IPAA
J-pouch
MRI enterography
perianal fistula
ulcerative colitis
Journal
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Titre abrégé: Colorectal Dis
Pays: England
ID NLM: 100883611
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
revised:
07
01
2023
received:
17
05
2022
accepted:
13
03
2023
medline:
24
7
2023
pubmed:
2
5
2023
entrez:
2
5
2023
Statut:
ppublish
Résumé
We aimed to determine whether ulcerative colitis patients with preoperative negative computed tomography or magnetic resonance enterography (CTE/MRE) were less likely to develop Crohn's disease-like pouch complications (CDLPC) and establish risk factors and predictors for developing CDLPC. This was a single centre retrospective analysis of patients with ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBDU) who underwent total proctocolectomy with ileal J-pouch between January 2010 and December 2020. The study group comprised patients with negative preoperative CTE/MRE and the control group included patients operated without preoperative CTE/MRE. A total of 131 patients were divided into the negative CTE/MRE study group (76 [58%] patients) and control group (55 [42%] patients). There were no significant differences in incidence rates (21% vs. 23.6%, p = 0.83), time to developing CDLPC from ileostomy closure (22.3 vs. 23.8 months; p = 0.81), pouchitis rates (23.6% vs. 27.2%; p = 0.68), or pouch failure rates (5.2 vs. 7.2; p = 0.71). Multivariate Cox regression analysis showed backwash ileitis (HR 4.1; p = 0.03, CI: 1.1-15.1), severe pouchitis (HR 3.4; p = 0.039, CI: 1.0-10.9), and history of perianal disease (HR 3.4; p = 0.017, CI: 1.4-39.6) were independent predictors for CDLPC. Negative findings on MRE/CTE prior to J-pouch surgery in ulcerative colitis should be interpreted with caution as it is does not reliably exclude or predict development of CDLPC. These patients should be preoperatively counselled concerning the possibility of developing CDLPC regardless of lack of positive findings on preoperative CTE/MRE. Patients with backwash ileitis with a previous history of perianal disease should be informed of the potentially increased risk of developing such complications.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1460-1468Informations de copyright
© 2023 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
Références
Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J. 1978;2:85-8.
Fazio VW, Kiran RP, Remzi FH, et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg. 2021;257:679-85.
Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, et al. Third European evidence-based consensus on diagnosis and Management of Ulcerative Colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and Ileo-anal pouch disorders. J Crohns Colitis. 2017;11:649-70.
Ross H, Steele SR, Varma M, Dykes S, Cima R, Buie WD, et al. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum. 2014;57:5-22.
Lightner AL, Mathis KL, Dozois EJ, Hahnsloser D, Loftus EV Jr, Raffals LE, et al. Results at up to 30 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Inflamm Bowel Dis. 2017;23:781-90.
Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR. Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Br J Surg. 2007;94:333-40.
Yanai H, Ben-Shachar S, Mlynarsky L, Godny L, Leshno M, Tulchinsky H, et al. The outcome of ulcerative colitis patients undergoing pouch surgery is determined by pre-surgical factors. Alimen Pharmacol Ther. 2017;46:508-15.
Melton GB, Kiran RP, Fazio VW, He J, Shen B, Goldblum JR, et al. Do preoperative factors predict subsequent diagnosis of Crohn's disease after ileal pouch-anal anastomosis for ulcerative or indeterminate colitis? Colorectal Dis. 2010;12:1026-32.
Shamah S, Schneider J, Korelitz BI. High incidence of recurrent Crohn's disease following colectomy for ulcerative colitis revealed with long follow-up. Dig Dis Sci. 2018;63:446-51.
Barnes EL, Kochar B, Jessup HR, Herfarth HH. The incidence and definition of Crohn's disease of the pouch: a systematic review and meta-analysis. Inflamm Bowel Dis. 2019;25:1474-80.
Heuthorst L, Wasmann KATGM, Reijntjes MA, Hompes R, Buskens CJ, Bemelman WA. Ileal pouch-anal anastomosis complications and pouch failure: a systematic review and meta-analysis. Ann Surg. 2021;2:e074.
Tulchinsky H, Hawley PR, Nicholls RJ. Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann Surg. 2003;238:229-34.
Syal G, Shemtov R, Bonthala N, Vasiliauskas EA, Feldman EJ, Zaghiyan K, et al. Pre-pouch ileitis is associated with development of Crohn's disease-like complications and pouch failure. J Crohns Colitis. 2021;15:960-8.
Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749-53.
Wang K, Huang L, Huang W, Liu R, Chen X, Guo Z, et al. Predictive value of CT Enterography index for postoperative intra-abdominal septic complications in patients with Crohn's disease: implications for surgical decision-making. Dis Colon Rectum. 2021;64:964-76.
Lightner AL, Jia X, Zaghiyan K, Fleshner PR. IPAA in known preoperative Crohn's disease: a systematic review. Dis Colon Rectum. 2021;64:355-64.
Shen B, Achkar JP, Connor JT, Ormsby AH, Remzi FH, Bevins CL, et al. Modified pouchitis disease activity index: a simplified approach to the diagnosis of pouchitis. Dis Colon Rectum. 2003;46:748-53.
Kayal M, Plietz M, Rizvi A, Radcliffe M, Riggs A, Yzet C, et al. Inflammatory pouch conditions are common after ileal pouch anal anastomosis in ulcerative colitis patients. Inflamm Bowel Dis. 2020;26:1079-86.
Tolan DJM, Greenhalgh R, Zealley IA, Halligan S, Taylor SA. MR enterographic manifestations of small bowel Crohn's disease. Radiographics. 2010;30:367-684.
Arrossi AV, Kariv Y, Bronner MP, et al. Backwash ileitis does not affect pouch outcome in patients with ulcerative colitis with restorative proctocolectomy. Clin Gastroenterol Hepatol. 2011;9:981-8.
Murrell Z, Vasiliauskas E, Melmed G, Lo S, Targan S, Fleshner P. Preoperative wireless capsule endoscopy does not predict outcome after ileal pouch-anal anastomosis. Dis Colon Rectum. 2010;53:293-300. https://doi.org/10.1007/DCR.0b013e3181b71a2c
Nasseri Y, Melmed G, Wang HL, Targan S, Fleshner P. Rigorous histopathological assessment of the colectomy specimen in patients with inflammatory bowel disease unclassified does not predict outcome after ileal pouch-anal anastomosis. Am J Gastroenterol. 2010;105:155-61. https://doi.org/10.1038/ajg.2009.510
Dayton MT, Larsen KR, Christiansen DD. Similar functional results and complications after ileal pouch-anal anastomosis in patients with indeterminate vs ulcerative colitis. Arch Surg. 2002;137:690-5.
Zaghiyan K, Kamiński JP, Barmparas G, Fleshner P. De novo Crohn's disease after ileal pouch-anal anastomosis for ulcerative colitis and inflammatory bowel disease unclassified: long-term follow-up of a prospective inflammatory bowel disease registry. Am Surg. 2016;82:977-81.
Abdelrazeq AS, Wilson TR, Leitch DL, Lund JN, Leveson SH, et al. Ileitis in ulcerative colitis: is it a backwash? Dis Colon Rectum. 2005;48:2038-46.
Schmidt CM, Lazenby AJ, Hendrickson RJ, et al. Preoperative terminal ileal and colonic resection histopathology predicts risk of pouchitis in patients after ileoanal pull-through procedure. Ann Surg. 1998;227:654-65.
Heuthorst L, Wasmann KATGM, et al. Ileal pouch-anal anastomosis complications and pouch failure: a systematic review and meta-analysis. Ann Surg Open. 2021;2I:e074.
Heimann TM, Swaminathan S, Slater GI, Kurtz RJ. Perianal fistula after ileoanal pouch in patients with ulcerative colitis: a review of 475 patients operated on at a major IBD center. Dis Colon Rectum. 2022;65:76-82.
Kayal M, Plietz M, Wang YHW, et al. Crohn's disease like pouch inflammation is associated with decreased odds of secondary ileostomy closure after ileal pouch anal anastomosis. Inflamm Bowel Dis. 2021;28(7):1123-5. izab289.
Hueting WE, Buskens E, van der Tweel I, Gooszen HG, van Laarhoven CJHM. Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9,317 patients. Dig Surg. 2005;22:69-79.
Diederen K, Sahami SS, Tabbers MM, Benninga MA, Kindermann A, Tanis PJ, et al. Outcome after restorative proctocolectomy and ileal pouch-anal anastomosis in children and adults. Br J Surg. 2017;104:1640-7.