Histopathology of Colectomy Specimens Predicts Endoscopic Pouch Phenotype in Patients with Ulcerative Colitis

Shintaro Akiyama, Jacob E. Ollech, Cindy Traboulsi, Victoria Rai, Laura R. Glick, Yangtian Yi, Joseph Runde, Andrea D. Olivas, Christopher R. Weber, Russell D. Cohen, Kinga B.Skowron Olortegui, Roger D. Hurst, Konstantin Umanskiy, Benjamin D. Shogan, Michele A. Rubin, Sushila R. Dalal, Atsushi Sakuraba, Joel Pekow, Eugene B. Chang, John HartNeil H. Hyman, David T. Rubin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: The endoscopic appearance in patients with “pouchitis” after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) can be quite heterogenous. Patients with an endoscopic phenotype resembling Crohn’s disease (CD) are at high risk of pouch loss. Aims: We aimed to assess how the histopathology of colectomy specimens predicts endoscopic pouch phenotypes in UC. Methods: We retrospectively assessed pouchoscopies from patients with UC who underwent IPAA and classified pouch findings into 7 main 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 from ileostomy takedown. We assessed the clinical and pathological data including deep, focal inflammation, granulomas, and terminal ileal involvement in the colectomy specimens. Logistic regression analysis was performed to identify contributing factors to each phenotype. Results: This study included 1,203 pouchoscopies from 382 patients with UC. On multivariable analysis, deep inflammation was significantly associated with pouch fistulas (Odds ratio 3.27; 95% confidence interval 1.65–6.47; P = 0.0007). Of the 75 patients with deep inflammation, only two patients (2.7%) were diagnosed with CD based on pathology review. Terminal ileal involvement significantly increased the risk of afferent limb involvement (Odds ratio 2.96; 95% confidence interval 1.04–8.47; P = 0.04). There were no significant associations between other microscopic features and phenotypes. Conclusions: We identify histologic features of colectomy specimens in UC that predict subsequent pouch phenotypes. Particularly, deep inflammation in the resected colon was significantly associated with pouch fistulas, a pouch phenotype with poor prognosis.

Original languageEnglish (US)
Pages (from-to)4020-4031
Number of pages12
JournalDigestive diseases and sciences
Issue number8
StatePublished - Aug 2022


  • Chicago classification of pouchitis
  • Colectomy specimens
  • Deep inflammation

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology


Dive into the research topics of 'Histopathology of Colectomy Specimens Predicts Endoscopic Pouch Phenotype in Patients with Ulcerative Colitis'. Together they form a unique fingerprint.

Cite this