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- Title
Surveillance pouchoscopy for dysplasia: Cleveland Clinic Ileoanal Pouch Anastomosis Database.
- Authors
Lightner, A. L.; Vaidya, P.; Vogler, S.; McMichael, J.; Jia, X.; Regueiro, M.; Qazi, T.; Steele, S. R.; Church, J.
- Abstract
Background: No formal guidelines exist for surveillance pouchoscopy following ileal pouch–anal anastomosis (IPAA) for ulcerative colitis. Methods: All adults who had previously had IPAA for ulcerative colitis, and underwent a pouchoscopy between 1 January 2010 and 1 January 2020, were included. Results: A total of 9398 pouchoscopy procedures were performed in 3672 patients. The majority of the examinations were diagnostic (8082, 86·0 per cent; 3260 patients) and the remainder were for routine surveillance (1316, 14·0 per cent; 412 patients). Thirteen patients (0·14 per cent of procedures) were found to have biopsy‐proven neoplasia at the time of pouchoscopy; seven had low‐grade dysplasia (LGD) (0·07 per cent; all located in the anal transition zone), none had high‐grade dysplasia (HGD) and six (0·06 per cent) had invasive adenocarcinoma (4 in anal transition zone and 6 in pouch). Of the six patients with adenocarcinoma, four had neoplasia at the time of proctocolectomy (2 adenocarcinoma, 1 LGD, 1 HGD); all six were symptomatic with anal bleeding or pelvic pain at the time of pouchoscopy, had a negative surveillance pouchoscopy examination within 2 years of diagnosis of adenocarcinoma, had palpable masses on digital rectal examination, and had visible lesions at the time of pouchoscopy. Conclusion: Surveillance pouchoscopy is not recommended in asymptomatic patients because significant neoplasia following IPAA for ulcerative colitis is rare.
- Subjects
CLEVELAND Clinic Foundation; RESTORATIVE proctocolectomy; DIGITAL rectal examination; ULCERATIVE colitis; PELVIC pain; ANAL tumors
- Publication
British Journal of Surgery, 2020, Vol 107, Issue 13, p1826
- ISSN
0007-1323
- Publication type
Article
- DOI
10.1002/bjs.11811