Abstract | BACKGROUND: OBJECTIVE: The aim of this study is to report the long-term outcomes of prepouch ileitis. DESIGN: We followed up a cohort of patients with prepouch ileitis that was originally described in 2009. Patients were followed up until the last recorded clinic attendance or at the point of pouch failure. Follow-up data collected included stool frequency, endoscopic findings, treatment, and overall pouch function. SETTING: We accessed a prospectively maintained database at our institution between January 2009 and January 2017. PATIENTS: Three of the 34 patients originally described in 2009 were lost to follow-up; we reanalyzed data on the remaining 31. MAIN OUTCOME MEASURE: The rate of pouch failure was defined as the need for ileostomy or pouch revision. RESULTS: All 31 patients had coexisting pouchitis at index diagnosis of prepouch ileitis. The median length of follow-up from the index pouchoscopy was 98 (range, 27-143) months. Seven (23%) patients who had an index pouchoscopy with prepouch ileitis went on to pouch failure, which is significantly higher than expected (p = 0.03). Five (71%) of these patients had chronic pouchitis, and 2 (29%) had small-bowel obstruction due to prepouch stricture. Two patients had evidence that would support possible Crohn's disease at long-term follow-up. LIMITATIONS: This was a retrospective analysis. Because of the nature of the study, there was some missing information that may have influenced the results. Our study is further limited by small patient numbers. CONCLUSIONS: Prepouch ileitis is associated with a significantly increased risk of pouch failure compared with the overall reported literature for restorative proctocolectomy. Prepouch ileitis does not appear to be strongly predictive of Crohn's disease at long-term follow-up. See Video Abstract at http://links.lww.com/DCR/A480.
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Authors | Jonathan P Segal, Simon D McLaughlin, Omar D Faiz, Ailsa L Hart, Susan K Clark |
Journal | Diseases of the colon and rectum
(Dis Colon Rectum)
Vol. 61
Issue 4
Pg. 472-475
(Apr 2018)
ISSN: 1530-0358 [Electronic] United States |
PMID | 29369899
(Publication Type: Journal Article, Observational Study, Video-Audio Media)
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Topics |
- Adult
- Databases, Factual
- Female
- Follow-Up Studies
- Humans
- Ileostomy
- Incidence
- Male
- Middle Aged
- Pouchitis
(diagnosis, epidemiology, surgery)
- Proctocolectomy, Restorative
(statistics & numerical data)
- Prognosis
- Reoperation
(statistics & numerical data)
- Retrospective Studies
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