Abstract
Background
The risk of developing cancer in the ileal pouch of patients with surgery for ulcerative colitis has not been defined. Dysplasia in the pouch is quite rare. Although some suggest pouch surveillance based on previous histological assessments, there are no guidelines for surveillance of these patients. The aim of our study was to investigate that risk and identify time intervals for ileoanal pouch surveillance.
Methods
Endoscopy and biopsies of the ileal pouch were performed at 3, 6, and/or 12 months after ileal pouch-anal anastomosis (IPAA) became functional. Biopsies were evaluated by two pathologists using Riddel’s criteria. Interim data analysis using descriptive statistics is reported.
Results
Thirty-eight patients have entered the study. Average patient age at 3, 6, and 12 months of surveillance was 39.1, 36.8, and 39.1 years, respectively. Average disease duration was 8.2 years. Ten of 38 cases (26%) had colonic dysplasia prior to surgery. Dysplasia within the pouch was reported in one patient 6 months after IPAA became functional. This patient demonstrated no dysplasia at 12 months or statistical divergence by age, duration of disease or history of colonic dysplasia prior to IPAA. No subgroup of patients with dysplasia was identified to calculate cumulative risk or perform comparative statistical analysis.
Conclusion
A study with longer follow-up after IPAA should precede any attempt to recommend routine surveillance. However, the finding of dysplasia early after surgery underscores the importance of early pouch surveillance in our population, at least until definite predisposing variables are identified.
Similar content being viewed by others
References
Setti Carraro P, Talbot IC, Nicholls RJ. Long term appraisal of the histological appearances of the ileal reservoir mucosa after restorative proctocolectomy for ulcerative colitis. Gut. 1994;35:1721–1727.
Veress B, Reinholt FP, Lindquist K, et al. Long-term histomorphological surveillance of the pelvic ileal pouch: dysplasia develops in a subgroup of patients. Gastroenterology. 1995;109:1090–1097.
Heuschen UA, Heuschen G, Herfarth C. Ileoanal pouch as rectal substitute. Chirurg. 1999;70(5):530–542.
Das P, Johnson MW, Tekiss PP, et al. Risk of dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis. Colorectal disease. 2007;9:15–27.
Riddell RH, Goldman H, Ransohoff DF, et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Human Pathology. 1983;14:931–968.
Herline AJ, Meisinger LL, Rusin LC, et al. Is routine pouch surveillance for dysplasia indicated for ileoanal pouches? Dis Colon Rectum. 2003;46:156–159.
Hulten L, Willen R, Nilsson O, et al. Mucosal assessment for dysplasia and cancer in the ileal pouch mucosa in patients operated on for ulcerative colitis-a 30 year follow up study. Dis Colon Rectum. 2002;45:448–452.
Bentrem DJ, Wang KL, Stryker SJ. Adenocarcinoma in the ileal pouch occurring 14 years after restorative protocolectomy: report of a case. Dis Colon Rectum. 2003;46:544–546.
Gullberg K, Stahlberg D, Liljeqvist L, et al. Neoplastic transformation of the pelvic pouch mucosa in patients with ulcerative colitis. Gastroenterology. 1997;112:1487–1492.
Iwama T, Kamikawa J, Higuchi T, et al. Development of invasive adenocarcinoma in longstanding diverted ileal J-pouch for ulcerative colitis. Report of a case. Dis Colon Rectum. 2000;43:101–104.
Rodriguez-Sanjuan JC, Polavieja M, Naranjo A, Castillo J. Adenocarcinoma in an ileal pouch for ulcerative colitis. Dis Colon Rectum. 1995;38:779–780.
Sarigol S, Wyllie R, Gramlich T, et al. Incidence of dysplasia in pelvic pouches in pediatric patients after ileal pouch-anal anastomosis for ulcerative colitis. J Pediatr Gastroenterol Nutr. 1999;28:429–434.
Haray PN, Amarnath B, Weiss EG, et al. Low malignancy potential of the double stapled ileal pouch-anal anastomosis. British J Surg. 1996;83:1406–1408.
Börjesson L, Willen R, Haboubi N, et al. The risk of dysplasia and cancer in the ileal pouch mucosa after restorative proctocolectomy for ulcerative proctocolitis is low: a long term follow up study. Colorectal Dis. 2004;6:494–501.
Hassan C, Zullo A, Speziale G, et al. Adenocarcinoma of the ileoanal pouch anastomosis: an emerging complication? Int J Colorectal Dis. 2003;18(3):276–278.
Löfberg R, Liljeqvist L, Lindquist K, et al. Dysplasia and DNA aneuploidy in a pelvic pouch. Report of a case. Dis Colon Rectum. 1991;34(3):280–283.
Gullberg K, Lindforss U, Zetterquist H, et al. Cancer risk assessment in long-standing pouchitis. DNA aberrations are rare in transformed neoplastic pelvic pouch mucosa. Int J Colorectal Dis. 2002;17(2):92–97.
Elkowitz D, Daum F, Markowitz J, et al. Risk factors for carcinoma of the pelvic ileal pouch/anal canal in ulcerative colitis. Ann Clin Lab Sci. 2004;34:143–149.
Coull DB, Lee FD, Anderson JH, et al. Long-term cancer risk of the anorectal cuff following restorative proctocolectomy assessed by p53 expression and cuff dysplasia. Colorectal Dis. 2007;9(4):321–327.
Kariv R, Bennett A, Kariv Y, et al. Adenocarcinoma in ileal pouch-anal anastomosis: the Cleveland clinic experience. Am J Gastroenterol. 2007;102:S468. (abstract).
Shen B, Fazio V, Remzi F, et al. Clinical approach to diseases of ileal pouch-anal anastomosis. Am J Gastroenterol. 2005;100:2796–2807.
Shen B, Fu AZH, Lashner B, et al. Surveillance pouch endoscopy for the detection of dysplasia in ulcerative colitis patients with ileal pouch anal anastomosis is cost-effective. Am J Gastroenterol. 2007;102:S461. (abstract).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Meléndez Hernández, J.D., Jiménez-Huyke, C., Rosado, K. et al. Surveillance for Dysplasia in Patients with Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Interim Analysis. Dig Dis Sci 55, 2332–2336 (2010). https://doi.org/10.1007/s10620-009-1006-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-009-1006-y