TY - JOUR
T1 - Endoscopic Phenotype of the J Pouch in Patients With Inflammatory Bowel Disease
T2 - A New Classification for Pouch Outcomes
AU - Akiyama, Shintaro
AU - Ollech, Jacob E.
AU - Rai, Victoria
AU - Glick, Laura R.
AU - Yi, Yangtian
AU - Traboulsi, Cindy
AU - Runde, Joseph
AU - Cohen, Russell D.
AU - Skowron, Kinga B.
AU - Hurst, Roger D.
AU - Umanskiy, Konstantin
AU - Shogan, Benjamin D.
AU - Hyman, Neil H.
AU - Rubin, Michele A.
AU - Dalal, Sushila R.
AU - Sakuraba, Atsushi
AU - Pekow, Joel
AU - Chang, Eugene B.
AU - Rubin, David T.
N1 - Funding Information:
Funding Funding was provided in part by National Institute of Diabetes and Digestive and Kidney Diseases grants P30 DK42086 and RC2 DK122394, the BLS Family Foundation, and the GI Research Foundation of Chicago.
Funding Information:
Funding Funding was provided in part by National Institute of Diabetes and Digestive and Kidney Diseases grants P30 DK42086 and RC2 DK122394, the BLS Family Foundation, and the GI Research Foundation of Chicago. Conflicts of interest These authors disclose the following: Russell D. Cohen is on the speaker's bureau for AbbVie and Takeda, is a consultant/advisor for AbbVie Laboratories, BM/Celgene, Eli Lilly, Gilead Sciences, Janssen, Pfizer, Takeda, and UCB Pharma, has received clinical trial support/grants from AbbVie, BMS/Celgene, Boehringer Ingelheim, Crohn's and Colitis Foundation of America, Genentech, Gilead Sciences, Hollister, Medimmune, Mesoblast Ltd, Osiris Therapeutics, Pfizer, Receptos, RedHill Biopharma, Sanofi-Aventis, Schwarz Pharma, Seres Therapeutics, Takeda Pharma, and UCB Pharma; Michele A. Rubin has served as a consultant for Pfizer; Sushila R. Dalal has served as a consultant for Pfizer and is on the speaker's bureau for AbbVie; Joel Pekow has received grant support from AbbVie and Takeda, has served as a consultant for Veraste and CVS Caremark, and is on the advisory board for Takeda, Janssen, and Pfizer; Eugene B. Chang is the founder and chief medical officer of AVnovum Therapeutics; David T. Rubin has received grant support from Takeda and has served as a consultant for AbbVie, Abgenomics, Allergan, Inc, Arena Pharmaceuticals, Bellatrix Pharmaceuticals, Boehringer Ingelheim Ltd, Bristol-Myers Squibb, Celgene Corp/Syneos, Check-cap, Dizal Pharmaceuticals, GalenPharma/Atlantica, Genentech/Roche, Gilead Sciences, Ichnos Sciences SA, InDex Pharmaceuticals, Iterative Scopes, Janssen Pharmaceuticals, Lilly, Materia Prima, Narrow River Mgmt, Pfizer, Prometheus Laboratories, Reistone, Takeda, and Techlab, Inc, is the co-founder of Cornerstones Health, Inc, and GoDuRn, LLC, and is on the Board of Trustees of the American College of Gastroenterology. The remaining authors disclose no conflicts.
Publisher Copyright:
© 2022 AGA Institute
PY - 2022/2
Y1 - 2022/2
N2 - Background & Aims: Pouchitis is a common complication of ileal pouch–anal anastomosis (IPAA) in patients with ulcerative colitis who have undergone colectomy. Pouchitis has been considered a single entity despite a broad array of clinical and endoscopic patterns. We developed a novel classification system based on the pattern of inflammation observed in pouches and evaluated the contributing factors and prognosis of each phenotype. Methods: We identified 426 patients (384 with ulcerative colitis) treated with proctocolectomy and IPAA who subsequently underwent pouchoscopies at the University of Chicago between June 1997 and December 2019. We retrospectively reviewed 1359 pouchoscopies and classified them into 7 main pouch phenotypes: (1) normal, (2) afferent limb involvement, (3) inlet involvement, (4) diffuse, (5) focal inflammation of the pouch body, (6) cuffitis, and (7) pouch with fistulas noted 6 months after ileostomy takedown. Logistic regression analysis was used to assess factors contributing to each phenotype. Pouch survival was estimated by the log-rank test and the Cox proportional hazards model. Results: Significant contributing factors for afferent limb involvement were a body mass index of 25 or higher and hand-sewn anastomosis, for inlet involvement the significant contributing factor was male sex; for diffuse inflammation the significant contributing factors were extensive colitis and preoperative use of anti–tumor necrosis factor drugs, for cuffitis the significant contributing factors were stapled anastomosis and preoperative Clostridioides difficile infection. Inlet stenosis, diffuse inflammation, and cuffitis significantly increased the risk of pouch excision. Diffuse inflammation was associated independently with pouch excision (hazard ratio, 2.69; 95% CI, 1.34–5.41; P = .005). Conclusions: We describe 7 unique IPAA phenotypes with different contributing factors and outcomes, and propose a new classification system for pouch management and future interventional studies.
AB - Background & Aims: Pouchitis is a common complication of ileal pouch–anal anastomosis (IPAA) in patients with ulcerative colitis who have undergone colectomy. Pouchitis has been considered a single entity despite a broad array of clinical and endoscopic patterns. We developed a novel classification system based on the pattern of inflammation observed in pouches and evaluated the contributing factors and prognosis of each phenotype. Methods: We identified 426 patients (384 with ulcerative colitis) treated with proctocolectomy and IPAA who subsequently underwent pouchoscopies at the University of Chicago between June 1997 and December 2019. We retrospectively reviewed 1359 pouchoscopies and classified them into 7 main pouch phenotypes: (1) normal, (2) afferent limb involvement, (3) inlet involvement, (4) diffuse, (5) focal inflammation of the pouch body, (6) cuffitis, and (7) pouch with fistulas noted 6 months after ileostomy takedown. Logistic regression analysis was used to assess factors contributing to each phenotype. Pouch survival was estimated by the log-rank test and the Cox proportional hazards model. Results: Significant contributing factors for afferent limb involvement were a body mass index of 25 or higher and hand-sewn anastomosis, for inlet involvement the significant contributing factor was male sex; for diffuse inflammation the significant contributing factors were extensive colitis and preoperative use of anti–tumor necrosis factor drugs, for cuffitis the significant contributing factors were stapled anastomosis and preoperative Clostridioides difficile infection. Inlet stenosis, diffuse inflammation, and cuffitis significantly increased the risk of pouch excision. Diffuse inflammation was associated independently with pouch excision (hazard ratio, 2.69; 95% CI, 1.34–5.41; P = .005). Conclusions: We describe 7 unique IPAA phenotypes with different contributing factors and outcomes, and propose a new classification system for pouch management and future interventional studies.
KW - Endoscopic Phenotype
KW - Ileal Pouch–Anal Anastomosis
KW - Inflammatory Bowel Disease
KW - Pouch Prognosis
KW - Pouchitis
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UR - http://www.scopus.com/inward/citedby.url?scp=85104343847&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2021.02.010
DO - 10.1016/j.cgh.2021.02.010
M3 - Article
C2 - 33549868
AN - SCOPUS:85104343847
VL - 20
SP - 293-302.e9
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
SN - 1542-3565
IS - 2
ER -