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

Uri Netz, Norman J. Galbraith, Stephen O'Brien, Jane Carter, Stephen Manek, Robert E. Petras, Susan Galandiuk

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

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.

Original languageEnglish
Pages (from-to)535-541
Number of pages7
JournalSurgery
Volume163
Issue number3
DOIs
StatePublished - 1 Mar 2018

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