Colectomy for patients with ulcerative colitis and primary sclerosing cholangitis - what next?
OBJECTIVE
Primary sclerosing cholangitis (PSC) occurs in 2%-8% of patients who suffer from ulcerative colitis (UC). For patients who require colectomy, ileal pouch-anal anastomosis (IPAA) or ileorectal anastomosis (IRA) is employed to preserve continence.We evaluated the outcomes after IPAA and IRA for patients with UC-PSC, using patients with UC but without PSC as controls (UC-only group).


METHODS
In a case-control study conducted at Sahlgrenska University Hospital, Sweden, patients with UC-PSC (N=48; 31 IPAA and 17 IRA) were compared to patients with UC only (N=113; 62 IPAA and 51 IRA). Functional outcomes (Öresland score), pouchitis, surgical complications, and failure were evaluated.


RESULTS
For patients with IPAA, the median Öresland scores were similar for the two groups: 5 (range, 0-13) for the UC-PSC group and 5 for the UC-only group (range, 0-12; p>0.05). However, the IRA scores were significantly different at 7 (range, 2-11) and 3 (range, 0-11) for the respective groups (p=0.005). Pouchitis was more frequent in patients with UC-PSC. Complication rates did not differ. For patients with IPAA, the failure rate was 16% for those in the UC-PSC group versus 6% for those in the UC-only group (p>0.05); the corresponding results for IRA were 53% versus 22% (p=0.03).


CONCLUSIONS
For cases of IPAA, pouchitis seems to be more common in patients with UC-PSC. However, the functional outcomes and failure rates are unaffected by concurrent PSC. For patients with UC-PSC, functional outcome is poor and the failure rate is high after IRA.
Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden. Electronic address: mattias.block@vgregion.se.
M
M
Block
Section for Gastroenterology, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Norwegian PSC Research Centre, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
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KK
Jørgensen
Section for Gastroenterology, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; EpiGen Institute, Akershus University Hospital, Lorenskog, Norway.
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Oresland
Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
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E
Lindholm
Division of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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K
Grzyb
Department of Biostatistics, University of Oslo, Oslo, Norway.
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M
Cvancarova
Section for Gastroenterology, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Norwegian PSC Research Centre, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
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MH
Vatn
Section for Gastroenterology, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Norwegian PSC Research Centre, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
K M
KM
Boberg
Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
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Börjesson
D000328:Adult; D016022:Case-Control Studies; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000601:surgery*; D003082:Colectomy / Q000379:methods; D003093:Colitis, Ulcerative / Q000150:complications / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D016896:Treatment Outcome
Functional outcome; Ileal pouch-anal anastomosis; Ileorectal anastomosis; Pouchitis; Primary sclerosing cholangitis; Ulcerative colitis