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Laparoscopic Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Sanjiv Haribhakti, Rajat Srivastava
On pouchoscopy, pouchitis is characterized by the presence of diffuse erythema, friability, granularity, exudates, erosions, and/or ulcerations [22]. On histology, pouchitis is characterized by acute inflammation with neutrophil infiltration, crypt abscess, and mucosal ulceration, often superimposed on a background of chronic changes including villous atrophy, crypt distortion or hyperplasia, pyloric gland metaplasia, and chronic inflammatory cell infiltration [23]. Differential diagnosis includes Cuffitis, Crohn's disease, and surgery-associated mechanical complications such as anastomotic sinus or leak, decreased pouch compliance, diversion pouchitis, and irritable pouch syndrome (IPS).
Ulcerative colitis and indeterminate colitis in children
Published in Alejandra Vilanova-Sánchez, Marc A. Levitt, Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
Alessandra C. Gasior, Ross Maltz
A 12-year-old male with a history of UC has undergone the second stage of surgery of proctectomy and J-pouch creation. You have performed a contrast enema and the pouch appears to have smooth edges without the evidence of pouchitis. There is no evidence of fistula or stricture. A pouchoscopy confirms this as well.
Clinical results and microbiota changes after faecal microbiota transplantation for chronic pouchitis: a pilot study
Published in Scandinavian Journal of Gastroenterology, 2020
Sabrina Just Kousgaard, Thomas Yssing Michaelsen, Hans Linde Nielsen, Karina Frahm Kirk, Jakob Brandt, Mads Albertsen, Ole Thorlacius-Ussing
Patients were included in a 6-month prospective, open-label, single-centre cohort pilot-study. All patients were allocated to treatment with FMT delivered by enema from five faecal donors for 14 consecutive days. Patients were asked to keep a daily diary including clinical Pouchitis Disease Activity Index (cPDAI), stool frequency as well as record any adverse events during the 14-day treatment. At baseline and 30-day follow-up, patients underwent a pouchoscopy with collection of biopsies and faecal samples, and the complete Pouchitis Disease Activity Index (PDAI) was assessed [29]. Additionally, faecal samples and questions concerning cPDAI, stool frequency and adverse events were collected on a monthly basis until end of follow-up after a 6-month period. A cut-off score of seven points in the PDAI score at 30-day follow-up was used to distinguish between remission (PDAI <7) and relapse (PDAI ≥7).
Biologics and immunomodulators for treating Crohn’s disease developing after surgery for an initial diagnosis of ulcerative colitis: a review of current literature
Published in Scandinavian Journal of Gastroenterology, 2018
Abhijeet Yadav, Joshua Foromera, Kenneth R. Falchuk, Joseph D. Feuerstein
Making an accurate diagnosis of a new disease of CD/CDL conditions after an IPAA for UC is very challenging. It requires a careful assessment of the initial diagnosis of UC and typically when available, the colectomy specimen should be reviewed to determine if there was prior evidence of CD. To diagnose CD/CDL conditions of the pouch, a combined assessment of symptoms, endoscopy, histology, and radiography should be utilized. Usually, a pouchoscopy is the first diagnostic test that is performed to rule out pochitis as the underlying cause of symptoms. Deep serpiginous ulcers in the pouch may suggest CD but are not diagnostic. Ulcerated lesions in the afferent limb proximal to the pouch and ulcerated strictures at the pouch inlet, mid-pouch, or afferent limb in the absence of current NSAID use are all suggestive of CD [6]. On pathology, the finding of granulomas can be pathognomonic of CD but they are only present in ∼10% of cases of CD [7,8]. Pyloric gland metaplasia is also suggestive of CD and may be predictive of adverse clinical outcomes [9].
Endoscopic surveillance of colorectal cancer in inflammatory bowel diseases: a review of the literature
Published in Expert Review of Anticancer Therapy, 2020
Alessandro Vitello, Endrit Shahini, Fabio S. Macaluso, Gaetano C. Morreale, Emanuele Sinagra, Socrate Pallio, Marcello Maida
With regard to patients undergoing an IPAA, little evidence regarding the effectiveness of surveillance is currently available. The ASGE [15] and ECCO [3,91] guidelines recommend yearly pouchoscopy in patients with high-risk features (e.g. history of PSC, previous dysplasia or CRC, severely inflamed atrophic pouch mucosa). Conversely, in IPAA patients without risk factors, ECCO endoscopy guidelines suggest pouchoscopy every 5 years [91].