IPAA failure rates among IC patients

Sep 22, 2020 - E-Mentoring in IBD | Volume 13 • 2020

Issue 18

Clinical Question

How do indeterminate colitis (IC) patients fare with ileal pouch-anal anastomosis (IPAA)?

Editor’s Bottom Line

Patients with IC may have more complications after IPAA than do patients with ulcerative colitis (UC). This should be considered when deciding between permanent ileostomy and pouch construction.

Reference

Emile SH, Gilshtein H, Wexner SD. Outcome of Ileal Pouch-anal Anastomosis in Patients With Indeterminate Colitis: A Systematic Review and Meta-analysis. J Crohn’s Colitis. 2020;14(7):1010–20; https://academic.oup.com/ecco-jcc/article-abstract/14/7/1010/5698184?redirectedFrom=fulltext

Synopsis

Researchers compared the success of IPAA in patients with IC with that in patients with UC. They searched several electronic databases and found 17 studies, all retrospective case series. The studies included 1,057 patients with IC and 6,511 patients with UC. Patients were a median 33 years of age at the time of surgery and nearly all had a J-pouch constructed.

The results showed 8.6% of patients with IC experienced pouch failure during a median follow-up of 56 months, compared to 6.7% of those with UC. This difference was not statistically significant. There was also no significant difference in the rate of fecal incontinence. However, 58% and 49% of IC and UC patients experienced complications of IPAA, which was a significant difference (odds ratio [OR]: 2.6; p<0.001). Complications significantly more common among IC patients included pouch fistula (OR: 4.98; p<0.001), pelvic sepsis (OR: 3.98; p=0.002), pelvic or cuff abscess (OR: 4.5; p<0.001), perineal complications (OR: 5.13; p<0.001), and diagnosis of Crohn’s disease after IPAA (OR: 2.57; p<0.001). Rates of pouchitis, anastomotic leak, stricture and small bowel obstruction were similar among IC and UC patients. The presence of strictures or small bowel obstruction at the time of surgery were significant predictors of pouch failure among IC patients.

Details

Study Design: Retrospective meta-analysis

Funding: None

Allocation: Not applicable

Setting: Multicenter

Level of Evidence: 2a (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.

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