Skip to main content
SpringerLink
Log in

Mucosal changes in ileal pouches after restorative proctocolectomy for ulcerative and crohn's colitis

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Inflammation and dysplasia may affect the ileal pouch after restorative proctocolectomy and ileal pouchanal anastomosis. The aim of this prospective study was to evaluate the morphologic changes and the risk of dysplasia within the pouch after ileal pouch-anal anastomosis. METHODS: Thirty-seven patients with ileal pouch-anal anastomosis underwent endoscopies and biopsies of the pouch: 21 patients were affected by ulcerative colitis and 16 by Crohn's colitis. The mucosal biopsy specimens were studied to investigate the degree of acute and chronic inflammation and the occurrence of dysplasia. A score system was calculated for each patient and correlated with the histologic diagnosis of ulcerative colitis or Crohn's colitis. RESULTS: After a median follow-up of 85 (range, 7–198) months, the inflammation histologic score evaluated was 3.8 (95 percent confidence interval, 2.4–5.1) and 3.5 (95 percent confidence interval, 2.6–4.3), respectively, in patients with Crohn's colitis and ulcerative colitis (mean and 95 percent confidence interval;P=0.74, not significant), and no patient developed mucosal dysplasia. Fifteen patients (40.5 percent) developed clinical pouchitis that occurred in Crohn's colitis (9/16 patients or 56 percent) and in ulcerative colitis (6/21 patients or 28 percent;P not significant). The score was 4.1 (95 percent confidence interval, 3.2–5) in patients with pouchitis and 3.2 (95 percent confidence interval, 2.1–4.3) in patients without clinical pouchitis (P=0.012) and was 4.1 (95 percent confidence interval, 2.6–5.5) and 4 (95 percent confidence interval, 2.9–5.3), respectively, in pouchitis patients with Crohn's colitis and ulcerative colitis. CONCLUSION: No difference in the inflammation histologic score was observed in ileal pouches after restorative proctocolectomy for ulcerative and Crohn's colitis. In our series, which includes those patients with longer follow-up (>5 years) or with chronic unremitting pouchitis, no case of dysplasia was found. The occurrence of pouchitis was higher in the case of ileal pouch-anal anastomosis for Crohn's disease than for ulcerative colitis, but no difference in the severity of the histologic score was noted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Panis Y, Poupard B, Nemet J, Lavergne A, Hautefeuille P, Valleur P. Ileal pouch-anal anastomosis for Crohn's disease. Lancet 1996;347:854–7.

    Article  PubMed  Google Scholar 

  2. de Silva HJ, Millard PR, Kettlewell M, Mortensen NJ, Prince C, Jewell DP. Mucosal characteristics of pelvic ileal pouches. Gut 1991;32:61–5.

    PubMed  Google Scholar 

  3. Svaninger G, Nordgren S, Öresland T, Hultén L. Incidence and characteristics of pouchitis in the Kock continent ileostomy and the pelvic pouch. Scand J Gastroenterol 1993;28:695–700.

    PubMed  Google Scholar 

  4. Shepherd NA, Jass JR, Duval I, Moskowitz RL, Nicholls RJ, Morson BC. Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol 1987;40:601–7.

    PubMed  Google Scholar 

  5. Penna C, Dozois RR, Tremaine W,et al. Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut 1996;38:234–9.

    PubMed  Google Scholar 

  6. Setti Carraro P, Talbot IC, Nicholls RJ. Longterm appraisal of the histological appearances of the ileal reservoir mucosa after restorative protocolectomy for ulcerative colitis. Gut 1994;35:1721–7.

    PubMed  Google Scholar 

  7. Shepherd NA. The pelvic ileal reservoir: apocalypse later? BMJ 1991;301:886–7.

    Google Scholar 

  8. Lofberg R, Liljeqvist L, Lindquist K, Veress B, Reinholt FP, Tribukait B. Dysplasia and DNA aneuploidy in a pelvic pouch: report of a case. Dis Colon Rectum 1991;34:280–4.

    Article  PubMed  Google Scholar 

  9. Veress B, Reinholt F, Lindquist K, Löfberg R, Liljeqvist L. Long-term histomorphological surveillance of the pelvic ileal pouch: dysplasia develops in a subgroup of patients. Gastroenterology 1995;109:1090–7.

    Article  PubMed  Google Scholar 

  10. Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1978;2:85–8.

    PubMed  Google Scholar 

  11. Riddel RH, Goldman H, Ransohoff DF,et al. Dysplasia in inflammatory bowel disease. Hum Pathol 1983;14:931–66.

    PubMed  Google Scholar 

  12. Moskowitz RL, Shepherd NA, Nicholls RJ. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorectal Dis 1986;1:167–74.

    Article  PubMed  Google Scholar 

  13. Sandborn WJ, Tremaine WJ, Batts KP, Pemberton JH, Phillips SF. Pouchitis after ileal pouch-anal anastomosis: a Pouchitis Disease Activity Index. Mayo Clin Proc 1994;69:409–15.

    PubMed  Google Scholar 

  14. Setti Carraro P, Talbot IC, Nicholls RJ. Patterns of distribution of endoscopic and histological changes in the ileal reservoir after restorative proctocolectomy for ulcerative colitis. A long-term follow-up study. Int J Colorectal Dis 1998;13:103–7.

    Google Scholar 

  15. Apel R, Choen Z, Andrews CW Jr, McLeod R, Steinhart H, Odze R. Prospective evaluation of early morphological changes in pelvic ileal pouches. Gastroenterology 1994;107:435–43.

    PubMed  Google Scholar 

  16. Veress B, Reinholt FP, Lindquist K, Liljeqvist L. Prospective studies of the mucosa of the ileoanal pouch. Gastroenterology 1995;108:953–4.

    Article  PubMed  Google Scholar 

  17. Yee LF, Fleshman JW. Current concepts in pouchitis. Perspect Colon Rectal Surg 1998;11:71–82.

    Google Scholar 

  18. Gillen CD, Walmsley RS, Prior P, Andrews HA, Allan RN. Ulcerative colitis and Crohn's disease: a comparison of the colorectal cancer risk in extensive colitis. Gut 1994;35:1590–2.

    PubMed  Google Scholar 

  19. Rubio CA, Befrits R. Colorectal adenocarcinoma in Crohn's disease: a retrospective histologic study. Dis Colon Rectum 1997;40:1072–8.

    Article  PubMed  Google Scholar 

  20. Memon MA, Nelson H. Extraintestinal manifestation of inflammatory bowel disease. Perspect Colon Rectal Surg 1996;9:1–27.

    Google Scholar 

  21. Pancer RD, Kendall AJ. The liver in ulcerative colitis. BMJ 1954;2:1030.

    Google Scholar 

  22. Berrebi W, Chaussade S, Levy Bruhl A,et al. Treatment of Crohn's disease recurrence after ileoanal anastomosis by azathioprine. Dig Dis Sci 1993;38:1558–60.

    Article  PubMed  Google Scholar 

  23. Nicholls RJ. Ileoanal reservoir. State of the art. Tech Coloproctol 1996;2:71–4.

    Google Scholar 

  24. Rothenberger DA, Fazio VW, Keighley MR, Schoetz D, Wolff BG. Ileopouch-anal anastomosis: current controversies. Perspect Colon Rectal Surg 1991;4:233–64.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From the Coloproctology Unit, Villa Claudia Hospital, Rome, Italy

    G. M. Ettorre M.D.,  M. Pescatori M.D. (F.R.C.S.) & A. Crescenzi M.D.

  2. Department of Surgery and Pathology, Lariboisière Hospital, Paris, France

    Y. Panis M.D., Ph.D., J. Nemeth M.D. & P. Valleur M.D.

Authors
  1. G. M. Ettorre M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Pescatori M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Panis M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Nemeth M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Crescenzi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Valleur M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Ettorre, G.M., Pescatori, M., Panis, Y. et al. Mucosal changes in ileal pouches after restorative proctocolectomy for ulcerative and crohn's colitis. Dis Colon Rectum 43, 1743–1748 (2000). https://doi.org/10.1007/BF02236861

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02236861

Key words

Search

Navigation