Digestive Diseases and Sciences

, Volume 55, Issue 8, pp 2332–2336 | Cite as

Surveillance for Dysplasia in Patients with Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Interim Analysis

  • Jorge D. Meléndez Hernández
  • Carlos Jiménez-Huyke
  • Kathia Rosado
  • Carmen González-Keelan
  • Juan J. Lojo
  • Esther A. Torres
Original Article



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.


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.


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.


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.


Ileal pouch-anal anastomosis Ulcerative colitis Surveillance Dysplasia 


  1. 1.
    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.CrossRefPubMedGoogle Scholar
  2. 2.
    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.CrossRefPubMedGoogle Scholar
  3. 3.
    Heuschen UA, Heuschen G, Herfarth C. Ileoanal pouch as rectal substitute. Chirurg. 1999;70(5):530–542.CrossRefPubMedGoogle Scholar
  4. 4.
    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.CrossRefPubMedGoogle Scholar
  5. 5.
    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.CrossRefGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    Rodriguez-Sanjuan JC, Polavieja M, Naranjo A, Castillo J. Adenocarcinoma in an ileal pouch for ulcerative colitis. Dis Colon Rectum. 1995;38:779–780.CrossRefPubMedGoogle Scholar
  12. 12.
    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.CrossRefPubMedGoogle Scholar
  13. 13.
    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.CrossRefPubMedGoogle Scholar
  14. 14.
    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.CrossRefPubMedGoogle Scholar
  15. 15.
    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.PubMedGoogle Scholar
  16. 16.
    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.CrossRefPubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    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.PubMedGoogle Scholar
  19. 19.
    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.CrossRefPubMedGoogle Scholar
  20. 20.
    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).CrossRefGoogle Scholar
  21. 21.
    Shen B, Fazio V, Remzi F, et al. Clinical approach to diseases of ileal pouch-anal anastomosis. Am J Gastroenterol. 2005;100:2796–2807.CrossRefPubMedGoogle Scholar
  22. 22.
    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).CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Jorge D. Meléndez Hernández
    • 1
  • Carlos Jiménez-Huyke
    • 1
  • Kathia Rosado
    • 3
  • Carmen González-Keelan
    • 3
  • Juan J. Lojo
    • 2
  • Esther A. Torres
    • 1
  1. 1.Department of Internal MedicineUniversity of Puerto Rico School of MedicineSan JuanPuerto Rico
  2. 2.Department of SurgeryUniversity of Puerto Rico School of MedicineSan JuanPuerto Rico
  3. 3.Department of Pathology and Laboratory MedicineUniversity of Puerto Rico School of MedicineSan JuanPuerto Rico

Personalised recommendations