Use of a monoclonal antibody to sucrase-isomaltase for evaluation of the columnar cuff after stapled restorative proctocolectomy.
OBJECTIVE
Restorative proctocolectomy with a double-stapled pouch-anal anastomosis retains a cuff of diseased columnar mucosa (columnar cuff) in the upper anal canal that may require biopsy. Biopsying this can be difficult and colonic phenotypic change in the pouch can lead to errors interpreting the histology. This study was designed to investigate the use of a monoclonal antibody to sucrase-isomaltase for differentiating ileal pouch from columnar cuff mucosa. Then, by using this antibody, the ability to accurately take and report biopsies from the anal canal was examined.


METHODS
The technique of staining for sucrase-isomaltase was developed. From 113 patients who had a double-stapled pouch-anal anastomosis, 467 formalin-fixed biopsies and 177 fresh-frozen biopsies were taken from the ileal pouch, columnar cuff, or anal transitional zone. Biopsies were stained with a monoclonal antibody to sucrase-isomaltase, and fixed biopsies were routinely reported after staining with hematoxylin and eosin.


RESULTS
A monoclonal antibody to sucrase-isomaltase reliably discriminated between ileal from rectal mucosa. A biopsy of columnar cuff mucosa as reported by routine histology was obtained during 72 percent of attempted outpatient examinations. Sucrase-isomaltase staining of reported columnar cuff biopsies showed that biopsies were of pouch rather than columnar cuff in 4.4 percent (95 percent confidence interval, 2-8) of outpatient examinations.


CONCLUSIONS
The monoclonal antibody to sucrase-isomaltase used in this study may have a clinical role when interpreting columnar cuff biopsies from patients being investigated for pouch dysfunction, or in patients having surveillance biopsies to exclude neoplasia in the columnar cuff.
Department of Surgery, University of Otago, Dunedin Hospital, Dunedin, New Zealand. mark.thompson-fawcett@otago.ac.nz
Mark W
MW
Thompson-Fawcett
Neil J
NJ
McC Mortensen
Derek P
DP
Jewel
Bryan F
BF
Warren
D000911:Antibodies, Monoclonal; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000201:enzymology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa / Q000201:enzymology* / Q000473:pathology; D011184:Postoperative Period; D016737:Proctocolectomy, Restorative; D011379:Prognosis; D012680:Sensitivity and Specificity; D012812:Sigmoidoscopy; D013194:Staining and Labeling; D013394:Sucrase-Isomaltase Complex / Q000276:immunology* / Q000378:metabolism; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures
D000911:Antibodies, Monoclonal; D015415:Biomarkers; D013394:Sucrase-Isomaltase Complex