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De Novo Crohn's Disease of the Pouch in Children Undergoing Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Jarchin, Lauren*; Spencer, Elizabeth A.*; Khaitov, Sergey; Greenstein, Alexander; Jossen, Jacqueline*; Lai, Joanne*; Dunkin, David*; Pittman, Nanci*; Benkov, Keith*; Dubinsky, Marla C.*

Journal of Pediatric Gastroenterology and Nutrition: October 2019 - Volume 69 - Issue 4 - p 455–460
doi: 10.1097/MPG.0000000000002406
Original Articles: Gastroenterology: Inflammatory Bowel Disease
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Background: Approximately 10% of children with ulcerative colitis (UC) undergo colectomy with ileal pouch-anal anastomosis (IPAA). We aimed to describe the postoperative outcomes, with an emphasis on chronic pouch inflammation including de novo Crohn disease (CD) at a tertiary care inflammatory bowel disease center.

Methods: Electronic medical records of all children who underwent colectomy ≤18 years between 2008 and 2017 were reviewed. Clinical and laboratory data were recorded. Primary outcome was frequency of chronic pouch inflammation including de novo CD. Secondary outcomes included early (≤30 days from index surgery) and late postoperative complications. Descriptive statistics (median and interquartile range) summarized the data and univariate analysis tested associations with outcomes.

Results: Fifty-eight children underwent colectomy and 56 completed IPAA. Median age at diagnosis was 14 years (12–16.2) and at colectomy 16.2 years (14.2–17.7) with median follow-up of 13 months (5–43). Sixty-six percent underwent 3-stage IPAA and 78% were biologic exposed. Eleven had chronic pouchitis, 73% antibiotic refractory and 25% met criteria for de novo CD by median of 19 months (9–41). A total of 21% and 50% experienced early and late surgical complications, most commonly ileus and recurrent IPAA stricture. The pouch failure rate was 3.6%. Chronic pouch inflammation was associated with a later diagnosis of de novo CD (P = 0.0025).

Conclusions: In pediatric UC, CD is not uncommon after IPAA. Chronic pouch inflammation often precedes a diagnosis of de novo CD. Families should be informed of the short- and long-term outcomes in children before UC surgery.

*Department of Pediatrics

Department of Surgery, Mount Sinai Hospital and Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, New York, NY.

Address correspondence and reprint requests to Lauren Jarchin, MD, Mount Sinai Hospital, Icahn School of Medicine, 1 Gustave L. Levy Place, Box 1656, New York, NY 10029 (e-mail: lauren.jarchin@mssm.edu).

Received 17 January, 2019

Accepted 9 May, 2019

M.C.D. is Consultant for Janssen, Abbvie, UCB, Takeda, Pfizer, Prometheus labs, Genentech, Salix, Celgene Research support; Takeda, Pfizer, Janssen. The remaining authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,