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

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

Journal of Pediatric Gastroenterology and Nutrition: May 23, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002406
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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 post-operative outcomes, with an emphasis on chronic pouch inflammation including de novo Crohn's disease (CD) at a tertiary care inflammatory bowel disease (IBD) center.

Methods: Electronic medical records of all children who underwent colectomy ≤18 years between 2008–2017 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 post-operative complications. Descriptive statistics (median and interquartile range [IQR]) 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 prior to UC surgery.

*Department of Pediatrics, Mount Sinai Hospital and Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, New York, NY 10029

Department of Surgery, Mount Sinai Hospital and Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, New York, NY 10029.

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, USA (e-mail: lauren.jarchin@mssm.edu).

Received 17 January, 2019

Accepted 9 May, 2019

Funding: No funding from any agency in the public, commercial, or not-for-profit sector has been provided for the research.

Author contributions: Author contributions: Marla C. Dubinsky and Lauren Jarchin contributed to the conception and design of the study, analysis and interpretation of data, and drafting the article. Lauren Jarchin contributed to the acquisition of data with the help of Keith Benkov, David Dunkin, Jacqueline Jossen, Joanne Lai, Nanci Pittman, Elizabeth Spencer, Alex Greenstein and Sergey Khaitov. Marla Dubinsky made critical revisions of the draft and contributed to important intellectual content and final approval of the version to be submitted.

Conflicts of Interest: Marla Dubinsky, MD; Consultant for Janssen, Abbvie, UCB, Takeda, Pfizer, Prometheus labs, Genentech, Salix, Celgene Research support; Takeda, Pfizer, Janssen. No other conflicts to report.

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