Abstract
INTRODUCTION: Patients with ulcerative colitis and primary sclerosing cholangitis have an increased risk of developing carcinoma both in the bile ducts and in the colon. PURPOSE: To investigate whether this patient group also has an increased risk of developing atrophy and neoplasia in the ileal pouch mucosa after construction of a pelvic pouch with an ileoanal anastomosis or a continent Kock ileostomy. METHODS: Flexible video endoscopic examinations of the ileal pouch were performed in 16 patients with ulcerative colitis and primary sclerosing cholangitis and in 16 matched patients with ulcerative colitis without sclerosing cholangitis. Biopsies were sampled from different locations in the pouch for histologic assessment of mucosal atrophy and dysplasia and for flow cytometric DNA analysis assessing chromosomal aberrations. RESULTS: The patients with sclerosing cholangitis developed moderate or severe atrophy in the pouch significantly more often (P < 0.01). Persistent severe mucosal atrophy was revealed in eight patients with sclerosing cholangitis and only in two controls. One patient with sclerosing cholangitis had high-grade dysplasia in multiple locations. Low-grade dysplasia was assessed in three patients with sclerosing cholangitis and in two of the controls. DNA aneuploidy was displayed in three patients, all with sclerosing cholangitis and dysplasia. All patients with neoplastic transformation had a pouch with ileoanal anastomosis and a long pouch duration (> 8 years). CONCLUSION: Patients with ulcerative colitis and primary sclerosing cholangitis with an ileal reservoir are more prone to developing mucosal atrophy in the pouch and seem to have a higher risk of neoplastic transformation in the pouch mucosa than patients with ulcerative colitis without sclerosing cholangitis.
Similar content being viewed by others
References
RH Wiesner PM Grambsch ER Dickson et al. (1989) ArticleTitlePrimary sclerosing cholangitis Hepatology 10 430–436
U Broomé R Olsson L Lööf et al. (1996) ArticleTitleNatural history and prognostic factors in 305 Swedish patients with primary sclerosing cholangitis Gut 38 610–615
A Bergquist H Glaumann U Broomé (1998) ArticleTitleRisk factors and clinical presentation of hepatobiliary carcinoma in patients with primary sclerosing cholangitis (PSC) - a case control study Hepatology 27 311–316
U Broomé R Löfberg B Veress LS Eriksson (1995) ArticleTitlePrimary sclerosing cholangitis in ulcerative colitis - evidence for increased neoplastic potential Hepatology 22 1404–1408
D Kornfeld A Ekbom T Ihre (1997) ArticleTitleIs there an increased risk for colorectal cancer in patients with ulcerative colitis and concomitant primary sclerosing cholangitis? A population based study Gut 41 522–525
FP Reinholt B Veress K Lindquist L Liljeqvist (1989) ArticleTitleQualitative assessment and morphometry in the study of the ileal reservoir after restorative proctocolectomy APMIS 97 97–104
B Veress FP Reinholt K Lindquist L Liljeqvist (1990) ArticleTitleDifferent types of mucosal adaption on the ileal reservoir after restorative proctocolectomy. A two-year follow-up study APMIS 98 786–796
B Veress FP Reinholt K Lindquist et al. (1995) ArticleTitleLong-term histomorphological surveillance of the pelvic ileal pouch Gastroenterology 109 1090–1097
R Löfberg L Liljeqvist K Lindquist B Veress FP Reinholt B Tribukait (1991) ArticleTitleDysplasia and DNA aneuploidy in a pelvic pouch Dis Colon Rectum 34 280–284
K Gullberg D Ståhlberg L Liljeqvist et al. (1997) ArticleTitleNeoplastic transformation of the pelvic pouch mucosa in patients with ulcerative colitis Gastroenterology 112 1487–1492
M Vieth C Grünewald C Niemeyer M Stolte (1998) ArticleTitleAdenocarcinoma in an ileal pouch after prior proctocolectomy for carcinoma in a patient with ulcerative pancolitis Virchows Arch 433 281–284
UA Heuschen G Heuschen F Autschbach EH Allemeyer C Herfarth (2001) ArticleTitleAdenocarcinoma in the ileal pouch Int J Colorectal Dis 16 126–130
D Ståhlberg R Löfberg (1999) ArticleTitleUnderlying cholangiocarcinoma in a patient with high-grade dysplasia in the pelvic pouch (letter) Inflammatory Bowel Disease 5 150–151
RH Riddell H Goldman DF Ransohoff et al. (1983) ArticleTitleDysplasia in inflammatory bowel disease Hum Pathol 14 931–966
J Castro T Heiden N Wang B Tribukait (1993) ArticleTitlePreparation of cell nuclei from fresh tissues for high-quality DNA flow cytometry Cytometry 14 793–804
R Löfberg O Broström P Karlén et al. (1992) ArticleTitleDNA aneuploidy in ulcerative colitis Gastroenterology 102 1149–1154
C Penna RR Dozois WJ Tremaine et al. (1996) ArticleTitlePouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis Gut 38 234–239
MW Thompson-Fawcett V Marcus M Redston Z Cohen RS McLeod (2001) ArticleTitleRisk of dysplasia in long-term ileal pouches and pouches with chronic pouchitis Gastroenterology 121 275–281
P Marchesa BA Lashner IC Lavery et al. (1997) ArticleTitleThe risk of cancer and dysplasia among ulcerative colitis patients with primary sclerosing cholangitis Am J Gastroenterol 92 1285–1288
K Shetty L Rybicki A Brzezinski WD Carey BA Lashner (1999) ArticleTitleThe risk for cancer or dysplasia in ulcerative colitis patients with primary sclerosing cholangitis Am J Gastroenterol 94 1643–1649
LO Nilsson NG Kock I Lindgren HE Myrvold BM Philipson C Åhrén (1980) ArticleTitleMorphological and histochemical changes in the mucosa of the continent ileostomy reservoir 6–10 years after its construction Scand J Gastroenterol 15 737–747
KG Helander C Åhrén BM Philipson BM Samuelsson B Öjerskog (1990) ArticleTitleStructure of mucosa in continent ileal reservoirs 15–19 years after construction Hum Pathol 21 1235–1238
CL Cox DR Butts MP Roberts RA Wessels HR Bailey (1997) ArticleTitleDevelopment of invasive adenocarcinoma in a long-standing Kock continent ileostomy Dis Colon Rectum 40 500–503
Author information
Authors and Affiliations
About this article
Cite this article
Ståhlberg, D., Veress, B., Tribukait, B. et al. Atrophy and Neoplastic Transformation of the Ileal Pouch Mucosa in Patients With Ulcerative Colitis and Primary Sclerosing Cholangitis. Dis Colon Rectum 46, 770–778 (2003). https://doi.org/10.1007/s10350-004-6655-5
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-6655-5