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Guide to endoscopy of the ileo-anal pouch following restorative proctocolectomy with ileal pouch-anal anastomosis; indications, technique, and management of common findings

McLaughlin, Simon D. MB, BS1,2,3,*; Clark, Susan K. MD4; Thomas-Gibson, Siwan MD5; Tekkis, Paris P. MD1; Ciclitira, Paul J. PhD3; Nicholls, John R. MChir1

doi: 10.1002/ibd.20874
Clinical Review

Restorative proctocolectomy (RPC) with ileal pouch–anal anastomosis is the surgical procedure of choice for patients with ulcerative colitis (UC). It is also performed in selected patients with familial adenomatous polyposis (FAP). A significant proportion of patients will develop pouch dysfunction. Flexible pouchoscopy is the most important initial investigation in patients with dysfunction. It is also important in UC and FAP surveillance. The aim is to provide gastroenterologists with a clear understanding of the technique, indications, and diagnostic pitfalls when investigating RPC patients with flexible pouchoscopy. Flexible pouchoscopy for the investigation of RPC patients with pouch dysfunction has a high diagnostic yield, with most causes of pouch dysfunction identifiable during this procedure. The risk of developing dysplasia following RPC is low. Surveillance pouchoscopy is only recommended in those with FAP, those with a previous history of dysplasia or carcinoma, primary sclerosing cholangitis, those with a retained rectal cuff, and those with Type C histological changes. Flexible pouchoscopy is a useful first-line investigation in patients with pouch dysfunction. It can be performed without sedation and has a high diagnostic yield; it is also important as part of surveillance in FAP and selected UC patients.

(Inflamm Bowel Dis 2009)

1Department of Biosurgery and Surgical Technology, Imperial College, London, UK

2Department of Gastroenterology, St. Mark's Hospital, London, UK

3Department of Gastroenterology, Nutritional Sciences Division, King's College London, London, UK

4Department of Surgery, St. Mark's Hospital, London, UK

5Wolfson Unit for endoscopy, St. Mark's Hospital, London, UK

Received for publication December 1, 2008; Accepted December 15, 2008.

Supported by the St. Mark's Hospital Foundation (to S.M.).

*Department of Gastroenterology, St. Mark's Hospital, Watford Road, London HA1 3UJ, UK (e-mail:

DOI 10.1002/ibd.20874

Published online 29 January 2009 in Wiley InterScience (

© Crohn's & Colitis Foundation of America, Inc.
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