title: The prognosis of clinical course and the analysis of the frequency of the inflammation and dysplasia in the intestinal J-pouch at the patients after restorative proctocolectomy due to FAP.
abstract: OBJECTIVE
  The main operative method in familial adenomatous polyposis (FAP) patients is restorative proctocolectomy with "J"-shaped pouch and temporary loop ileostomy. The aim of the study was the analysis of the frequency of the dysplasia and inflammation in the intestinal pouch and prognosis of the clinical course in FAP patients after restorative proctocolectomy.
  
  
  METHODS
  A group of 165 FAP patients (86 females and 79 males, mean age 22.49 ± 12) subjected to a restorative proctocolectomy in the years 1985-2009 was analyzed. Clinical data coming from follow-up observation in the period of 2004-2009 were evaluated. In all patients, clinical examination and endoscopy with polypectomy and/or biopsy of pouch mucosa were done.
  
  
  RESULTS
  The mean time of pouchitis occurrence after an ileal pouch-anal anastomosis was 6 months. Mean time for low-grade dysplasia was 14 months. The time difference of low-grade dysplasia after the above procedure as compared to pouchitis alone was substantial. Mean time for high-grade dysplasia was 16 months and for neoplasia even 19 months. It was estimated that early pouchitis happening within the first year after surgery occurs in 5% of patients, low-grade dysplasia 4 years later in 7% of cases, high-grade dysplasia 7 years later in around 10% of patients and neoplasia 14 years after surgery in 15% of cases.
  
  
  CONCLUSIONS
  In conclusion, the Polyposis Registry encompassing whole country is the best way of controlling FAP patients. The regular lifelong endoscopic monitoring gives the opportunity of the early detection of the dysplasia and can protect against neoplasia.
authors.affiliation: Department of General, Gastroenterological and Endocrynological Surgery, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, 60-355, Poznań, Poland. tbanasiewicz@op.pl
authors.forename: Tomasz
authors.initials: T
authors.lastname: Banasiewicz
authors.forename: Ryszard
authors.initials: R
authors.lastname: Marciniak
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Kaczmarek
authors.forename: Piotr
authors.initials: P
authors.lastname: Krokowicz
authors.forename: Jacek
authors.initials: J
authors.lastname: Paszkowski
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Lozynska-Nelke
authors.forename: Piotr
authors.initials: P
authors.lastname: Gronek
authors.forename: Andrzej
authors.initials: A
authors.lastname: Plawski
authors.forename: Michal
authors.initials: M
authors.lastname: Drews
mesh_terms: D000236:Adenoma / Q000473:pathology; D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D019449:Pouchitis / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011379:Prognosis; D013997:Time Factors; D055815:Young Adult