Outcome of Ileal Pouch-anal Anastomosis in Patients With Indeterminate Colitis: A Systematic Review and Meta-analysis

Abstract Background Indeterminate colitis [IC] is type of inflammatory bowel disease that exhibits features of both ulcerative colitis [UC] and Crohn’s disease [CD]. The present meta-analysis aimed to assess the outcomes of ileal pouch-anal anastomosis [IPAA] in patients with IC in comparison with patients with UC. Methods A PRISMA-compliant systematic review of the outcome of IPAA in patients with IC was conducted. Electronic databases were searched, and full-text articles were reviewed to extract essential data. Main outcome measures were pouch failure and pouch-related complications. Results A total of 17 studies were included in this meta-analysis. There were 1057 patients with IC and 6511 patients with UC. The weighted mean pouch failure rate in patients with IC was 7.5 (95% confidence interval [CI]: 4.8–10.2) and the weighted mean complication rate was 67 [95% CI: 53.5–80.5]. As compared with patients with UC, patients with IC had significantly higher odds of developing complications after IPAA (odds ratio [OR]: 2.6, p <0.001): pouch fistula [OR:4.98, p <0.001], pelvic sepsis [OR:3.98, p =0.002], pelvic or cuff abscess [OR: 4.5, p <0.001], perineal complications [OR: 5.13, p <0.001], and ultimate diagnosis of CD [OR: 2.57, p <0.001]. Patients with IC and UC had similar odds of pouch failure, pouchitis, anastomotic leak, stricture, and small bowel obstruction. Conclusions Patients with IC had similar pouch failure rates, yet higher overall complication rates than patients with UC. Complications that tend to be higher after IPAA for patients with IC include pouch fistula, pelvic sepsis, abscess, perineal complications, and ultimate diagnosis of Crohn’s disease.

Download Full-text

P268 Ileal Pouch-Anal Anastomosis Complications and Pouch Failure: A Systematic Review and Meta-Analysis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.393 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S303-S303

Author(s):

L Heuthorst ◽

K Wasmann ◽

M Reijntjes ◽

R Hompes ◽

C Buskens ◽

...

Keyword(s):

Systematic Review ◽

Ileal Pouch ◽

Meta Analysis ◽

Ileal Pouch Anal Anastomosis ◽

Fistula Formation ◽

Pelvic Sepsis ◽

Pouch Failure ◽

Anal Anastomosis

Abstract Background Previous studies demonstrated wide variation in postoperative complication rates following ileal pouch-anal anastomosis (IPAA). This systematic review aims to assess the incidence of pouch failure and the correlation between IPAA-related complications and pouch failure. Methods A systematic review was performed by searching the MEDLINE, EMBASE, and Cochrane Library databases for studies reporting on pouch failure published from 1 January 2010 to 6 May 2020. A meta-analysis was performed using a random effects model. The relationship between pouch-related complications and pouch failure was assessed using Spearman’s correlations. Results Thirty studies comprising 22,978 patients were included. Included studies contained heterogenic patient populations, different procedural stages, varying definitions for IPAA-related complications, and different follow-up periods. The pooled pouch failure rate was 7.7% (95%CI5.56–10.59) and 10.3% (95%CI7.24–14.30) for studies with a median follow-up of ≥5 years and ≥10 years, respectively. Observed IPAA-related complications were anastomotic leakage (1–17%), pelvic sepsis (2–18%), fistula (1–30%), stricture (1–34%), pouchitis (11–61%) and Crohn’s disease of the pouch (0–18%). Pelvic sepsis (r=0.51, p<0.05) and fistula (r=0.63, p<0.01) were correlated with pouch failure. A sensitivity analysis including studies with a median follow-up of ≥5 years indicated that only fistula was significantly correlated with pouch failure (r=0.77, p<0.01). Conclusion Long-term pouch failure was correlated with fistula, suggesting that early septic complications may result in fistula formation during long-term follow-up, leading to increased risk of pouch failure. Pouch survival may be improved through standardized assessment of anastomotic integrity for early identification and adequate management of anastomotic leaks.

Download Full-text

P628 Anti-TNF therapy in refractory pouchitis and Crohn's disease-like complications of the pouch after ileal pouch-anal anastomosis following colectomy for ulcerative colitis: a systematic review and meta-analysis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx002.752 ◽

2017 ◽

Vol 11 (suppl_1) ◽

pp. S401-S401

Author(s):

M. Huguet ◽

B. Pereira ◽

M. Goutte ◽

F. Goutorbe ◽

C. Allimant ◽

...

Keyword(s):

Systematic Review ◽

Ulcerative Colitis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Ileal Pouch ◽

Meta Analysis ◽

Ileal Pouch Anal Anastomosis ◽

Anal Anastomosis

Download Full-text

Anti-TNF Therapy in Refractory Pouchitis and Crohn's Disease-Like Complications of the Pouch after Ileal Pouch-Anal Anastomosis following Colectomy for Ulcerative Colitis: A Systematic Review and Meta-Analysis

Gastroenterology ◽

10.1016/s0016-5085(17)31604-9 ◽

2017 ◽

Vol 152 (5) ◽

pp. S411

Author(s):

Mathilde Huguet ◽

Bruno Pereira ◽

Marion Goutte ◽

Gilles Bommelaer ◽

Anthony Buisson

Keyword(s):

Systematic Review ◽

Ulcerative Colitis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Ileal Pouch ◽

Meta Analysis ◽

Ileal Pouch Anal Anastomosis ◽

Anal Anastomosis

Download Full-text

Systematic Review and Meta-analysis of Outcomes After Ileal Pouch-anal Anastomosis in Primary Sclerosing Cholangitis and Ulcerative Colitis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab025 ◽

2021 ◽

Author(s):

Edward L Barnes ◽

Stefan D Holubar ◽

Hans H Herfarth

Keyword(s):

Systematic Review ◽

Ulcerative Colitis ◽

Primary Sclerosing Cholangitis ◽

Sclerosing Cholangitis ◽

Ileal Pouch ◽

Meta Analysis ◽

Ileal Pouch Anal Anastomosis ◽

Pouch Failure ◽

Increased Risk ◽

Anal Anastomosis

Abstract Background The optimal restorative surgical management of patients with concomitant diagnoses of primary sclerosing cholangitis and ulcerative colitis [PSC-UC] who require colectomy is controversial, given that patients may have an increased risk for pouchitis after ileal pouch-anal anastomosis [IPAA]. We aimed to compare rates of pouchitis and pouch failure among patients with and without PSC by performing a systematic review and meta-analysis. Methods A systematic search performed through August 18, 2020, identified 12 studies that compared the rates of pouchitis [n = 11] and/or pouch failure [n = 6] among patients with PSC-UC and UC alone. We then performed a meta-analysis using random effects modelling to estimate the odds of developing any episodes of pouchitis or pouch failure. Results A total of 4108 patients underwent an ileal pouch-anal anastomosis after proctocolectomy for UC. Of these, 3799 [92%] were performed for UC alone and 309 [8%] were performed for PSC-UC. In a meta-analysis of 11 studies, patients with PSC-UC compared with UC alone were significantly more likely to develop any pouchitis (63% vs 30%, odds ratio [OR] 4.21, 95% confidence interval [CI] 2.86–6.18), chronic pouchitis [47% vs 15%, OR 6.37, 95% CI 3.41–11.9], and pouch failure [10% vs 7%, OR 1.85, 95% CI 1.08–3.17]. Conclusions Patients with PSC-UC were more likely to experience pouchitis and pouch failure than patients with UC alone. The risks of inflammatory complications after IPAA must be weighed against the potential complications with other surgical procedures, and future studies comparing outcomes among these procedures may inform decision making in this population.

Download Full-text