Institutional members access full text with Ovid®

A Prospective Evaluation of the Long-Term Outcome of Ileal Pouch-Anal Anastomosis in Patients with Inflammatory Bowel Disease-Unclassified and Indeterminate Colitis.

Murrell, Zuri A. M.D.1; Melmed, Gil Y. M.D.2; Ippoliti, Andrew M.D.2; Vasiliauskas, Eric A. M.D.2; Dubinsky, Marla M.D.3; Targan, Stephan R. M.D.2; Fleshner, Phillip R. M.D.1

Diseases of the Colon & Rectum: May 2009 - Volume 52 - Issue 5 - pp 872-878
doi: 10.1007/DCR.0b013e31819f5d4c
Original Contributions

PURPOSE: The long-term outcome of ileal pouch-anal anastomosis in patients with indeterminate colitis is controversial. The aim of this study was to prospectively evaluate the long-term outcome of ileal pouch-anal anastomosis in a closely monitored cohort of patients with ulcerative colitis or indeterminate colitis.

METHODS: Prospectively generated clinical profiles on consecutive patients with ulcerative colitis or indeterminate colitis undergoing ileal pouch-anal anastomosis with close postoperative follow-up by one surgeon were reviewed. All patients were classified before surgery as either ulcerative colitis or inflammatory bowel disease-unclassified, and after surgery as either ulcerative colitis or indeterminate colitis. Long-term outcomes included acute pouchitis (antibiotic responsive), chronic pouchitis (antibiotic dependent or refractory), or de novo Crohn's disease (small inflammation above the pouch inlet or pouch fistula).

RESULTS: The study cohort of 334 patients were classified before surgery as ulcerative colitis in 237 (71 percent) and inflammatory bowel disease-unclassified in 97 (29 percent). After surgery, patients were classified as ulcerative colitis in 236 (71 percent) and indeterminate colitis in 98 (29 percent). After a median follow-up after stoma closure of 26 months, 53 patients (16 percent) developed acute pouchitis, 37 patients (11 percent) developed chronic pouchitis, and 40 patients (12 percent) developed de novo Crohn's disease. There was no significant difference in the incidence of acute pouchitis, chronic pouchitis, or de novo Crohn's disease between the ulcerative colitis, inflammatory bowel disease-unclassified, and indeterminate colitis patient groups.

CONCLUSION: The incidence of acute pouchitis, chronic pouchitis, and de novo Crohn's disease after ileal pouch-anal anastomosis do not differ significantly between patients with ulcerative colitis, inflammatory bowel disease-unclassified, or indeterminate colitis. Patients with inflammatory bowel disease-unclassified and indeterminate colitis can undergo ileal pouch-anal anastomosis and expect a long-term outcome equivalent to patients with ulcerative colitis.

1 Division of Colon and Rectal Surgery, Department of Surgery, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California

2 Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California

3 Division of Pediatric Gastroenterology, Department of Pediatrics, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California

Read at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 7 to 11, 2008.

Address of correspondence: Phillip R. Fleshner, M.D., 8737 Beverly Blvd., Suite 101, Los Angeles, California 90048. E-mail: pfleshner@aol.com

© The ASCRS 2009