MRI defecography of the ileal pouch-anal anastomosis—contributes little to the understanding of functional outcome
Variability in functional outcome after ileal pouch-anal anastomosis (IPAA) is to a large extent unexplained. The aim of this study was to use MRI to evaluate the morphology, emptying pattern and other pathology that may explain differences in functional outcome between well-functioning and poorly functioning pouch patients. A secondary aim was to establish a reference of normal MRI findings in pelvic pouch patients.
From a previous study, the best and worst functioning patients undergoing IPAA surgery between 2000 and 2013 had been identified and examined with manovolumetric tests (N = 47). The patients were invited to do a pelvic MRI investigating pouch morphology and emptying patterns, followed by a pouch endoscopy.
Forty-three patients underwent MRI examination. We found no significant morphological or dynamic differences between the well-functioning and poorly functioning pouch patients. There was no correlation between urge volume and the volume of the bony pelvis, and no correlation between emptying difficulties or leakage and dynamic MRI findings. Morphological MRI signs of inflammation were present in the majority of patients and were not correlated to histological signs of inflammation. Of the radiological signs of inflammation, only pouch wall thickness correlated to endoscopic pouchitis disease activity index scores.
It seems MRI does not increase the understanding of factors contributing to functional outcome after ileal pouch-anal anastomosis. Unless there is a clinical suspicion of perianal/peripouch disease or pelvic sepsis, MRI does not add value as a diagnostic tool for pelvic pouch patients. Endoscopy remains the golden standard for diagnosing pouch inflammation.
KeywordsUlcerative colitis Ileal pouch-anal anastomosis Functional outcome MRI dephecography
The research and publication is funded by research grants from the University of Oslo and Akershus University Hospital. The article is being submitted as an original article. The manuscript with related data, figures and tables has not previously been published and is not under consideration elsewhere, nor has it been presented at any scientific meeting or conference. There are no conflicts of interest associated with this publication.
All authors participated in conceiving the study and its design. MLS coordinated the study, performed the data analyses and statistical analyses and drafted the manuscript. AN and NB analysed and described the MRI images. All have read and approved the final manuscript.
Compliance with ethical standards
The study was approved by the regional and local ethics committee (REK no 2014/2206).
Conflict of interest
The authors declare that they have no conflicts of interest.
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