title: The extent of inflammation is a predictor for pouch-related complications in ileal pouches in patients with ulcerative or indeterminate colitis.
abstract: OBJECTIVE
  Limited data are available on the relationship between the histological features of the resected specimens in patients with ulcerative colitis (UC) or indeterminate colitis (IC) and the outcome of restorative proctocolectomy. The aim of our study was to determine if the histological features of the resected specimen in patients with UC and IC can predict ileal-pouch-related outcome.
  
  
  METHODS
  A review of all patients who had a restorative proctocolectomy created following completion proctectomy or proctocolectomy for UC and IC was performed.
  
  
  RESULTS
  Between 1992 and 2011, 142 patients (132 with UC and 10 with IC) were reviewed. After a median follow-up of 36 (3-149) months, 51 (35.9%) developed a pouch-related complication. Forty-two (29.7%) developed pouchitis while three (2.1%) developed a pouch-cutaneous fistula. Four (2.8%) had pouch failure, while stricture of the anastomosis was seen in three (2.1%) patients. The presence of extension of the inflammation into the muscularis propria of the resected specimen was associated with an increased risk of pouch-related complications (P = 0.01). The presence of submucosal oedema was also a significant risk factor (P = 0.03).
  
  
  CONCLUSIONS
  The extension of inflammation into the muscularis propria appears to predict pouch-related complications following restorative proctocolectomy for UC or IC.
authors.affiliation: Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Surgical Outcomes Research Centre, Central Sydney Area Health Service and University of Sydney, Sydney, Australia.
authors.forename: K-K
authors.initials: KK
authors.lastname: Tan
authors.forename: P
authors.initials: P
authors.lastname: Ravindran
authors.forename: C J
authors.initials: CJ
authors.lastname: Young
authors.forename: M J
authors.initials: MJ
authors.lastname: Solomon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003092:Colitis / Q000473:pathology / Q000601:surgery*; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery; D039021:Colonic Pouches / Q000009:adverse effects*; D017577:Cutaneous Fistula / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
keywords: Histology; colitis; ileal pouch; inflammation; inflammatory bowel disease; treatment outcome