Endoscopic therapy for pouch problems: Can we avoid surgery?

While restorative proctocolectomy and ileal pouch-anal anastomosis significantly improves patients' quality of life, the reconstructive surgery is often associated with various structural, inflammatory, and functional disorders. Those disorders have been traditionally managed with surgery. However, the past two decades have witnessed a growing role of endoscopic management of strictures, prolapse, anastomotic leaks, sinuses, fistulae, and polyps. The main advantages of endoscopic therapy are its less invasiveness in nature and better tolerance over surgery. Endoscopic sinusotomy is at least as effective as surgical pouch redo for a majority of pouch presacral sinuses, while carrying a lower risk for procedure-associated complications. (C) 2019 Elsevier Inc. All rights reserved.