Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?
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Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the “gold standard” procedure for patients with ulcerative colitis (UC) requiring surgical intervention. A de-functioning ileostomy is usually performed, as a step for the IPAA procedure. The aim of this study is to present the methodology and results of the routine double assessment of IPAA integrity in asymptomatic patients prior to the ileostomy reversal and evaluate its necessity.
This is a retrospective study of 61 UC patients, who underwent IPAA construction, in 2010–2016. A diverting ileostomy was created after IPAA construction, which was reversed at least 3 months later. A double assessment, with pouchogram and pouchoscopy, of IPAA integrity was performed, before stoma closure. Post-operative symptoms and signs of complications, imaging studies, and endoscopic findings were recorded during follow-up.
Prior to the ileostomy reversal, both pouchoscopy and pouchogram identified no patient with evidence of anastomotic leakage. During a mean follow-up of 3.67 years after ileostomy reversal, 11 patients developed complications but only one had signs of leakage, which presented as a pouch-vaginal fistula. The specificity of both the pouchogram and pouchoscopy reached 100% and the negative predictive value ranged between 98.4 and 100%.
The specificity of pouchoscopy and pouchogram prior to ileostomy closure, in asymptomatic patients with IPAA for UC, is very high in recognizing an intact anastomosis, but their combination did not alter the diagnostic accuracy or had any effect in further management. At least, pouchogram could be selectively performed only in patients with high-risk clinical indicators.
• The double assessment of ileal pouch-anal anastomosis with pouchogram and pouchoscopy, prior to ileostomy closure, specifically in patients with ulcerative colitis has not been evaluated before.
• The specificity of pouchoscopy and pouchogram prior to ileostomy closure, in asymptomatic patients with IPAA for UC, is very high in recognizing an intact anastomosis.
• However, their combination did not alter the diagnostic accuracy or had any effect in further management, in asymptomatic patients.
KeywordsIleal pouch-anal anastomosis Endoscopy, gastrointestinal Fluoroscopy Ulcerative colitis Proctocolectomy, restorative
Ileal pouch-anal anastomosis
- MD CT
Multi-detector computerized tomography
Magnetic resonance enterography
Magnetic resonance imaging
Number of cases
Negative predictive value
Positive predictive value
Contrast pouchogram-water-soluble contrast enema study
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Ioannis Papaconstantinou.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Approval was obtained by hospital’s scientific committee.
• Diagnostic or prognostic study
• Performed at one institution
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