Preoperative Endoscopic Activity Predicts the Occurrence of Pouchitis After Ileal Pouch–Anal Anastomosis in Ulcerative Colitis: A Multicenter Retrospective Study in China

Frontiers in Surgery

卷:8

Wenjun Ding¹  Weimin Xu¹  Wenbo Tang¹  Peng Du¹  Long Cui¹  Zhao Ding²  Wenhao Chen²  Qun Qian²  Hang Hu² 

[1] Department of Colorectal Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China;

[2] Department of Colorectal and Anal Surgery, Hubei Key Laboratory of Intestinal and Colorectal Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China;

关键词: ulcerative colitis;    pouchitis;    ulcerative colitis endoscopic index of severity;    mayo endoscopic score;    IPAA;   

DOI  :  10.3389/fsurg.2021.740349

来源: DOAJ

【 摘 要 】

Background: Pouchitis is the most common long-term complication after ileal pouch–anal anastomosis (IPAA) in patients with ulcerative colitis (UC). Ulcerative colitis endoscopic index of severity (UCEIS) and Mayo endoscopic score (MES) are widely used indices to evaluate endoscopic activity. This study aimed to clarify the predictive value of preoperative endoscopic activity on the occurrence of pouchitis after IPAA.Methods: Data of patients with UC who underwent IPAA from January 2008 to January 2020 were collected retrospectively. UCEIS and MES were based on the preoperative colonoscopy findings of two independent endoscopists.Results: A total of 102 patients with a median follow-up of 5 (interquartile range, 2–9) years were included in the study. Among them, 21.6% developed pouchitis. Compared with MES, UCEIS had a stronger correlation with pouchitis disease activity index. UCEIS ≥ 7 had the most significant receiver-operating characteristic (ROC) curve area of 0.747 with a sensitivity of 68.2% and specificity of 81.2% in predicting pouchitis, which outperformed MES of 3 with an ROC area of 0.679 with a sensitivity of 54.5% and specificity of 81.2%. Furthermore, we found that UCEIS ≥ 7 was an independent risk factor for post-IPAA pouchitis [odds ratio (OR), 8.860; 95% CI, 1.969–39.865, p < 0.001] with a higher risk than MES of 3 (OR, 5.200; 95% CI, 1.895–14.273; p = 0.001).Conclusion: Ulcerative colitis endoscopic index of severity performed better in predicting pouchitis after IPAA than MES. Earlier and more frequent postoperative colonoscopic surveillance should be considered in patients with preoperative UCEIS ≥ 7 to detect the occurrence of pouchitis earlier.

【 授权许可】

Unknown