title: Comparison of long-term outcomes of S and J pouches and continent ileostomies in ulcerative colitis patients with restorative proctocolectomy-experience in subspecialty pouch center.
abstract: BACKGROUND
  There are no published studies comparing pouch configurations and long-term adverse outcomes.
  
  
  OBJECTIVE
  To evaluate outcomes of ulcerative colitis (UC) patients undergoing restorative proctocolectomy with S-, J- pouches or continent ileostomy (CI).
  
  
  METHODS
  We conducted a historical cohort study from the prospectively maintained Pouch Registry. Demographic and clinical variables were evaluated with univariate and multivariable analyses.
  
  
  RESULTS
  Fourty-five patients with S pouches and 36 with CI (33 K pouches and 3 Barnett continent ileal reservoirs) were compared with 215 J pouches serving as controls (ratio 1:2.5). In multivariable analysis, patients with S pouches were 93% less likely to develop chronic antibiotic-refractory pouchitis (CARP) than subjects with J pouches (odds ratio [OR]=0.07; 95% confidence interval: <0.001, 0.54; p<0.001). However, no significant difference in the frequency of CARP was found between the CI and J pouch groups (OR=0.68; 95% confidence interval: 0.17, 2.00, p=0.40). Patients with S pouches were 8 times more likely (95% confidence interval: 3.7, 17.5; p<0.001) and patients with CI 5.6 had times more likely (95% confidence interval: 2.4, 13.3; p<0.001) to have pouch surgery-related complications than those with J pouches. There was no difference in the rate of CD of the pouch, pouch-associated hospitalization and pouch failure between the S- pouch, CI and J- pouch groups.
  
  
  CONCLUSIONS
  Patients with J pouches appeared to have a greater risk for chronic pouchitis than those with S-pouches and but had a lower risk for developing pouch surgery-related complications than those with S pouches or CI.
authors.affiliation: Departments of Gastroenterology/Hepatology, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mukewar
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Xianrui
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Quantitative Health Sciences, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Departments of Gastroenterology/Hepatology, The Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: shenb@ccf.org.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D008297:Male; D019449:Pouchitis / Q000188:drug therapy / Q000209:etiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Ileal pouch anal anastomosis;; Inflammatory bowel disease;; Restorative proctocolectomy;; S-pouch;; Ulcerative colitis