Can preoperative CT/MR enterography preclude the development of Crohn's disease-like pouch complications in ulcerative colitis patients undergoing J pouch surgery?

被引:2
作者
Freund, Michael R. [1 ,2 ]
Horesh, Nir [1 ,3 ]
Meyer, Ryan [1 ]
Garoufalia, Zoe [1 ]
Gefen, Rachel [1 ,4 ]
Emile, Sameh Hany [1 ,5 ]
Wexner, Steven D. [1 ,6 ]
机构
[1] Cleveland Clin Florida, Ellen Leifer Shulman & Steven Shulman Digest Dis C, Weston, FL USA
[2] Hebrew Univ Jerusalem, Fac Med, Shaare Zedek Med Ctr, Dept Gen Surg, Jerusalem, Israel
[3] Tel Aviv Univ, Fac Med, Sheba Med Ctr, Dept Surg & Transplantat, Tel Hashomer, Israel
[4] Hebrew Univ Jerusalem, Hadassah Med Org, Fac Med, Dept Gen Surg, Jerusalem, Israel
[5] Mansoura Univ Hosp, Colorectal Surg Unit, Mansoura, Egypt
[6] Cleveland Clin Florida, Ellen Leifer Shulman & Steven Shulman Digest Dis C, 2950 Cleveland Clin Blvd, Weston, FL 33331 USA
关键词
Crohn's disease-like pouch complications; CT enterography; IPAA; J-pouch; MRI enterography; perianal fistula; ulcerative colitis; INFLAMMATORY-BOWEL-DISEASE; ANAL ANASTOMOSIS; RESTORATIVE PROCTOCOLECTOMY; ILEAL; INDETERMINATE; DIAGNOSIS; COLECTOMY; ILEITIS; INDEX;
D O I
10.1111/codi.16587
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Aim: We aimed to determine whether ulcerative colitis patients with preoperative negative computed tomography or magnetic resonance enterography (CTE/MRE) were less likely to develop Crohn's disease-like pouch complications (CDLPC) and establish risk factors and predictors for developing CDLPC.Methods: This was a single centre retrospective analysis of patients with ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBDU) who underwent total proctocolectomy with ileal J-pouch between January 2010 and December 2020. The study group comprised patients with negative preoperative CTE/MRE and the control group included patients operated without preoperative CTE/MRE.Results: A total of 131 patients were divided into the negative CTE/MRE study group (76 [58%] patients) and control group (55 [42%] patients). There were no significant differences in incidence rates (21% vs. 23.6%, p = 0.83), time to developing CDLPC from ileostomy closure (22.3 vs. 23.8 months; p = 0.81), pouchitis rates (23.6% vs. 27.2%; p = 0.68), or pouch failure rates (5.2 vs. 7.2; p = 0.71). Multivariate Cox regression analysis showed backwash ileitis (HR 4.1; p = 0.03, CI: 1.1-15.1), severe pouchitis (HR 3.4; p = 0.039, CI: 1.0-10.9), and history of perianal disease (HR 3.4; p = 0.017, CI: 1.4-39.6) were independent predictors for CDLPC.Conclusions: Negative findings on MRE/CTE prior to J-pouch surgery in ulcerative colitis should be interpreted with caution as it is does not reliably exclude or predict development of CDLPC. These patients should be preoperatively counselled concerning the possibility of developing CDLPC regardless of lack of positive findings on preoperative CTE/MRE. Patients with backwash ileitis with a previous history of perianal disease should be informed of the potentially increased risk of developing such complications.
引用
收藏
页码:1460 / 1468
页数:9
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