Prevalence of primary sclerosing cholangitis in ulcerative colitis patients undergoing proctocolectomy and ileal pouch-anal anastomosis.
BACKGROUND
This study aimed to determine the prevalence of primary sclerosing cholangitis (PSC) among patients with ulcerative colitis (UC) needing proctocolectomy.


METHODS
The study sample included 441 consecutive patients who underwent proctocolectomy with ileal pouch-anal anastomosis from 1993 to 2004 at the Helsinki University Central Hospital. Liver biopsy samples were taken at operation. Patient groups with and without PSC were compared.


RESULTS
PSC was present in 52 (11.8%) patients. Only 19 of these had been diagnosed before surgery; 40 patients with PSC were detected by liver biopsy at the operation, making the sensitivity of perioperative liver biopsy to diagnose PSC 83.3%. The cumulative incidence of colorectal dysplasia or cancer in the UC patients with PSC (19% after 10 years and 43% after 20 years) was not significantly different than that of UC patients without PSC (24% after 10 years and 39% after 20 years). Pouchitis occurred more often in patients with PSC (25 of 52; 48.1% versus 101 of 389, 26.0%; P = 0.001). The failure rate of ileal pouch-anal anastomosis did not significantly differ between the 2 groups.


CONCLUSIONS
The prevalence of PSC among patients with UC needing proctocolectomy was higher than in patients with UC in general. Liver biopsy can be recommended as a safe adjunct at proctocolectomy for surveillance of any liver effects.
Lepistö
Anna
A
Department of Surgery, Helsinki University Central Hospital, Finland. anna.lepisto@hus.fi
Kärkkäinen
Päivi
P
Järvinen
Heikki J
HJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D001650:Bile Duct Neoplasms / Q000209:etiology; D001653:Bile Ducts, Intrahepatic; D001706:Biopsy; D018281:Cholangiocarcinoma / Q000209:etiology; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D003093:Colitis, Ulcerative / Q000150:complications / Q000473:pathology / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000209:etiology; D015995:Prevalence; D016737:Proctocolectomy, Restorative; D017211:Treatment Failure