European Radiology

, Volume 29, Issue 4, pp 1754–1761 | Cite as

Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?

  • Georgios ExarchosEmail author
  • Linda Metaxa
  • Antonios Gklavas
  • Vassilis Koutoulidis
  • Ioannis Papaconstantinou



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.

Key Points

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.


Ileal pouch-anal anastomosis Endoscopy, gastrointestinal Fluoroscopy Ulcerative colitis Proctocolectomy, restorative 



Ileostomy closure


Ileal pouch-anal anastomosis


Multi-detector computerized tomography


Magnetic resonance enterography


Magnetic resonance imaging


Number of cases


Negative predictive value




Positive predictive value




Standard deviation


Ulcerative colitis


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.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Approval was obtained by hospital’s scientific committee.


• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

Supplementary material

330_2018_5760_MOESM1_ESM.avi (164.2 mb)
Video 1 Lateral View of Pouchogram- Fluoroscopic water-soluble contrast enema study: there is leakage of contrast from the anterior wall of the pouch to the posterior wall of the vagina, which is opacified (AVI 168135 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.2nd Department of SurgeryNational and Kapodistrian University of Athens - Aretaieion HospitalAthensGreece
  2. 2.Radiology DepartmentSt Bartholomew’s HospitalLondonUK
  3. 3.Radiology DepartmentNational and Kapodistrian University of Athens, Aretaieion HospitalAthensGreece

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