title: Prevalence of adenomas and carcinomas in the ileal pouch after proctocolectomy in patients with familial adenomatous polyposis.
abstract: OBJECTIVE
  Restorative proctocolectomy has become the most common surgical option for patients with familial adenomatous polyposis (FAP). However, adenomas may develop in the ileal pouch mucosa over time, and even carcinoma in the pouch has been reported. Our aim was to evaluate the prevalence, nature, and etiology of ileal pouch and nonpouch adenomas and carcinoma in patients with FAP.
  
  
  METHODS
  This was a retrospective study of 31 FAP patients with Kock's continent ileostomy (Kock; n = 8), ileorectal anastomosis (IRA; n = 7), and ileal pouch-anal anastomosis (IPAA) (n = 16). All patients were followed with a standardized protocol including chromoendoscopy and biopsies of visible polyps in the ileal pouch and nonpouch mucosa.
  
  
  RESULTS
  Sixteen of 24 pouch patients (Kock and IPAA) developed adenomas in the ileal pouch mucosa, and all patients with IRA developed adenomas in the rectal mucosa. The prevalence of ileal adenomas was significantly higher in pouch patients than in IRA patients (P = 0.002). Only one patient with Kock showed adenoma in the prepouch area. Two cases of adenocarcinomas and one case of advanced adenoma were found in the ileal pouch mucosa.
  
  
  CONCLUSIONS
  Our results show a high frequency of adenomas in the ileal pouch mucosa, with evolution into carcinoma in some patients. Regular endoscopic surveillance of the pouch is recommended at a frequency similar to that for the rectal mucosa after IRA in pouch patients with FAP.
authors.affiliation: Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan. mtajika@aichi-cc.jp
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tajika
authors.forename: Tuneya
authors.initials: T
authors.lastname: Nakamura
authors.forename: Osamu
authors.initials: O
authors.lastname: Nakahara
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kawai
authors.forename: Kouji
authors.initials: K
authors.lastname: Komori
authors.forename: Takashi
authors.initials: T
authors.lastname: Hirai
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kato
authors.forename: Vikram
authors.initials: V
authors.lastname: Bhatia
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamao