Pouch Neoplasia Following IPAA in Patients with Underlying Inflammatory Bowel Diseases

  • Freeha Khan
  • Bo ShenEmail author


Patients undergoing restorative proctocolectomy with ileal pouch-anal anastomosis for underlying inflammatory bowel disease are at a low risk for developing low-grade dysplasia (LGD), high-grade dysplasia (HGD), or even adenocarcinoma in the pouch. However, those with a precolectomy colitis-associated neoplasia are at a high risk for pouch neoplasia. Patients with pouch adenocarcinoma have poor prognosis. A combined clinical, endoscopic, and histologic examination plays an essential role in diagnosis and management. Surveillance pouchoscopy is recommended for patients with a preoperative colitis-associated neoplasia.


Dysplasia Histopathology Ileal pouch Inflammatory bowel disease Neoplasia Pouchoscopy Surveillance 



Anal transitional zone


Colitis-associated neoplasia


Crohn’s disease


Colorectal cancer


Endoscopic mucosal resection


High-grade dysplasia


Inflammatory bowel disease


Indefinite for dysplasia


Ileal pouch-anal anastomosis


Low-grade dysplasia


Primary sclerosing cholangitis


Ulcerative colitis



The authors declared no financial conflict of interest.


  1. 1.
    Delaney CP, Fazio VW, Remzi FH, et al. Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg. 2003;238:221–8.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Fazio VW, Kiran RP, Remzi FH, et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg. 2013;257:679–85.CrossRefGoogle Scholar
  3. 3.
    Delaney CP, Remzi FH, Gramlich T, et al. Equivalent function, quality of life and pouch survival rates after ileal pouch-anal anastomosis for indeterminate and ulcerative colitis. Ann Surg. 2002;236:43–8.CrossRefGoogle Scholar
  4. 4.
    Scarpa M, van Koperen PJ, Ubbink DT, et al. Systematic review of dysplasia after restorative proctocolectomy for ulcerative colitis. Br J Surg. 2007;94:534–45.CrossRefGoogle Scholar
  5. 5.
    O’Riordain MG, Fazio VW, Lavery IC, et al. Incidence and natural history of dysplasia of the anal transitional zone after ileal pouch-anal anastomosis: results of a five-year to ten-year follow-up. Dis Colon Rectum. 2000;43:1660–5.CrossRefGoogle Scholar
  6. 6.
    Shepherd NA, Jass JR, Duval I, et al. Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol. 1987;40:601–7.CrossRefGoogle Scholar
  7. 7.
    Ziv Y, Fazio VW, Sirimarco MT, et al. Incidence, risk factors, and treatment of dysplasia in the anal transitional zone after ileal pouch-anal anastomosis. Dis Colon Rectum. 1994;37:1281–5.CrossRefGoogle Scholar
  8. 8.
    Banasiewicz T, Marciniak R, Paszkowski J, et al. Pouchitis may increase the risk of dysplasia after restorative proctocolectomy in patients with ulcerative colitis. Color Dis. 2012;14:92–7.CrossRefGoogle Scholar
  9. 9.
    Chambers WM, Mc CMNJ. Should ileal pouch-anal anastomosis include mucosectomy? Color Dis. 2007;9:384–92.CrossRefGoogle Scholar
  10. 10.
    Kariv R, Remzi FH, Lian L, et al. Preoperative colorectal neoplasia increases risk for pouch neoplasia in patients with restorative proctocolectomy. Gastroenterology. 2010;139:806–12.CrossRefGoogle Scholar
  11. 11.
    Derikx LA, Kievit W, Drenth JP, et al. Prior colorectal neoplasia is associated with increased risk of ileoanal pouch neoplasia in patients with inflammatory bowel disease. Gastroenterology. 2014;146:119–28.CrossRefGoogle Scholar
  12. 12.
    Remzi FH, Fazio VW, Delaney CP, et al. Dysplasia of the anal transitional zone after ileal pouch-anal anastomosis: results of prospective evaluation after a minimum of ten years. Dis Colon Rectum. 2003;46:6–13.CrossRefGoogle Scholar
  13. 13.
    Wu XR, Remzi FH, Liu XL, et al. Disease course and management strategy of pouch neoplasia in patients with underlying inflammatory bowel diseases. Inflamm Bowel Dis. 2014;20:2073–82.CrossRefGoogle Scholar
  14. 14.
    Liu ZX, Kiran RP, Bennett AE, et al. Diagnosis and management of dysplasia and cancer of the ileal pouch in patients with underlying inflammatory bowel disease. Cancer. 2011;117:3081–92.CrossRefGoogle Scholar
  15. 15.
    Schaus BJ, Fazio VW, Remzi FH, et al. Clinical features of ileal pouch polyps in patients with underlying ulcerative colitis. Dis Colon Rectum. 2007;50:832–8.CrossRefGoogle Scholar
  16. 16.
    Gonzalo DH, Collinsworth AL, Liu X. Common inflammatory disorders and neoplasia of the ileal pouch: a review of histopathology. Gastroenterology Res. 2016;9:29–38.CrossRefGoogle Scholar
  17. 17.
    Jiang W, Shadrach B, Carver P, Goldblum JR, Shen B, Liu X. Histomorphologic and molecular features of pouch and peripouch adenocarcinoma: a comparison with ulcerative colitis-associated adenocarcinoma. Am J Surg Pathol. 2012;36:1385–94.CrossRefGoogle Scholar
  18. 18.
    Liu ZX, Liu XL, Patil DT, et al. Clinical significance of indefinite for dysplasia on pouch biopsy in patients with underlying inflammatory bowel disease. J Gastrointest Surg. 2012;16:562–71.CrossRefGoogle Scholar
  19. 19.
    Van Schaik FD, Ten Kate FJ, Offerhaus GJ, et al. Misclassification of dysplasia in patients with inflammatory bowel disease: consequences for progression rates to advanced neoplasia. Inflamm Bowel Dis. 2011;17:1108–16.CrossRefGoogle Scholar
  20. 20.
    Eaden JA, Mayberry JF, British Society for Gastroenterology, Association of Coloproctology for Great Britain and Ireland. Guidelines for screening and surveillance of asymptomatic colorectal cancer in patients with inflammatory bowel disease. Gut. 2002;5:10.CrossRefGoogle Scholar
  21. 21.
    Gu J, Remzi FH, Lian L, et al. Practice pattern of ileal pouch surveillance in academic medical centers in the United States. Gastroenterol Rep. 2016;4:119–24.CrossRefGoogle Scholar
  22. 22.
    Gadacz TR, McFadden DW, Gabrielson EW, et al. Adenocarcinoma of the ileostomy: the latent risk of cancer after colectomy for ulcerative colitis and familial polyposis. Surgery. 1990;107:698.PubMedGoogle Scholar
  23. 23.
    Smart PJ, Sastry S, Wells S. Primary mucinous adenocarcinoma developing in an ileostomy stoma. Gut. 1988;29:1607.CrossRefGoogle Scholar
  24. 24.
    Coull DB, Lee FD, Henderson AP, et al. Risk of dysplasia in the columnar cuff after stapled restorative proctocolectomy. Br J Surg. 2003;90:72.CrossRefGoogle Scholar
  25. 25.
    Heuschen UA, Heuschen G, Autschbach F, et al. Adenocarcinoma in the ileal pouch: late risk of cancer after restorative proctocolectomy. Int J Color Dis. 2001;16:126–30.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Center for Inflammatory Bowel Disease, Digestive Disease and Surgery Institute-A31Cleveland ClinicClevelandUSA

Personalised recommendations