title: Endoscopic features associated with ileal pouch failure.
abstract: BACKGROUND
  Endoscopic features as predictors in pouch failure have not been studied. A well-constructed J-pouch typically has an "owl's eye" appearance in the proximal pouch body. We hypothesized that loss of the owl's eyes is associated with a high risk for pouch failure. The aim of this study was to evaluate the association between the distorted endoscopic appearance of owl's eyes and pouch failure.
  
  
  METHODS
  A total of 711 available pouch endoscopic images from 426 J-pouch patients were reviewed and scored blindly. A scoring system was generated for distorted owl's eyes. Multivariable analyses were performed to assess the link between the endoscopic feature or other variables and pouch failure.
  
  
  RESULTS
  A total of 37 patients (8.7%) developed pouch failure, with a median of 5.0 (interquartile range, 2.0-11.0) years of follow-up. Multivariable analyses showed that 2 or more "beak" abnormalities were associated with failure rates of 33.3%, 44.4%, and 72.2% by 5, 10, and 15 years of ileal pouch-anal anastomosis, respectively (hazard ratio = 3.7; 95% confidence interval, 1.5-9.0). In addition, diagnosis of Crohn's disease or surgical complications, the postoperative use of anti-tumor necrosis factor biologics, and a high cuff endoscopy inflammation score had statistically significant hazard ratios of 3.2, 5.8, and 1.5 for pouch failure, respectively.
  
  
  CONCLUSIONS
  Distorted appearance of "beak" portion of owl's eyes along with Crohn's disease of the pouch or surgery-related complications, postoperative use of biologics, and persistent cuffitis were the risk factors associated with pouch failure. The assessment of endoscopic owl's eye structure may provide an additional clue to predict pouch outcome.
authors.affiliation: Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Kareem
authors.initials: K
authors.lastname: Elder
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D039021:Colonic Pouches / Q000009:adverse effects*; D003424:Crohn Disease / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D007249:Inflammation / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D014409:Tumor Necrosis Factor-alpha