Long-term outcomes following ileal pouch-anal anastomosis in patients with indeterminate colitis

Netz, U., Galbraith, N. J. , O'Brien, S., Carter, J., Manek, S., Petras, R. E. and Galandiuk, S. (2018) Long-term outcomes following ileal pouch-anal anastomosis in patients with indeterminate colitis. Surgery, 163(3), pp. 535-541. (doi: 10.1016/j.surg.2017.11.014) (PMID:29325789)

Abstract

Background The advisability of performing ileal pouch–anal anastomosis for patients with indeterminate colitis is debated. Indeterminate colitis is found in up to 15% of inflammatory bowel disease colectomy specimens. We determined long-term outcomes in patients diagnosed with indeterminate colitis undergoing ileal pouch–anal anastomosis. Methods Fifty-six patients were included with a mean follow-up of 14 ± 7 years. Long-term behavior was defined based on surgeon assessment as “Crohn disease–like” in patients who subsequently developed clear signs of Crohn disease and as “non-Crohn disease–like.” Long-term function was assessed using the Cleveland Global Quality of Life and Pouch Functional Score. Results Thirty-nine percent of patients developed Crohn disease–like behavior, and 61% developed non-Crohn disease–like behavior. Both groups experienced a high rate of pouchitis (57%). Crohn disease–like patients required more anti-inflammatory/immunomodulatory medications (95% vs 18%, P < .001), dilatations for afferent-limb strictures (41% vs 0%, P < .001), and pouch reoperations (32% vs 6%, P = .02). Eight patients required pouch excision or diversion (7 with Crohn disease–like behavior). The Pouch Functional Score was equivalent between groups. Conclusion Long-term function after ileal pouch–anal anastomosis for the majority of indeterminate colitis patients was good. Approximately 40% eventually exhibited Crohn disease–like behavior, but the majority had acceptable function and quality of life. Ileal pouch–anal anastomosis is an appropriate surgical option for indeterminate colitis patients after informed consent.

• Item Type: Articles
• Additional Information: Funded by the John W. Price and Barbara Thruston Atwood Price Trust and the Mary K. Oxley Foundation.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Galbraith, Dr Norman
• Authors: Netz, U., Galbraith, N. J., O'Brien, S., Carter, J., Manek, S., Petras, R. E., and Galandiuk, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Surgery
• Publisher: Elsevier Inc.
• ISSN: 0039-6060
• ISSN (Online): 1532-7361
• Published Online: 08 January 2018