Neoplasia in the ileoanal pouch following colectomy in patients with ulcerative colitis and primary sclerosing cholangitis.
OBJECTIVE
Primary sclerosing cholangitis (PSC) is typically associated with inflammatory bowel disease (IBD), particularly ulcerative colitis (UC). PSC-IBD patients are at an increased risk for colorectal neoplasia. The ileal pouch-anal anastomosis (IPAA) is a treatment option for patients with medically refractory UC or neoplasia. However, little is known about the development of pouch neoplasia in PSC-UC patients following an IPAA. We aim to describe the incidence of pouch neoplasia in PSC-UC patients after an IPAA.


METHODS
We conducted a retrospective chart review of patients with a confirmed diagnosis of PSC and IBD who underwent colectomy with IPAA followed by pouch surveillance between 1995 and 2012.


RESULTS
Sixty-five patients were included in the cohort and were followed up from the time of colectomy/IPAA for a median of 6years. The most common indications for surgery were low-grade dysplasia (LGD) and refractory colitis. Only 3 patients developed evidence of neoplasia (LGD n=1, high-grade dysplasia n=1, adenocarcinoma n=1). The cumulative 5-year incidence of pouch neoplasia was 5.6% (95% confidence intervals [CI], 1.8%-16.1%).


CONCLUSIONS
Based on our short-term follow-up, surveying the pouch frequently appears to be an unnecessary practice in PSC-IBD patients. Longer follow-up will be needed to develop an optimal surveillance strategy for the development of dysplasia and cancer in such patients.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States.
Mohamad H
MH
Imam
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States.
John E
JE
Eaton
Department of Medicine, Mayo Clinic, Rochester, MN, United States.
Jason S
JS
Puckett
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States.
Edward V
EV
Loftus
Division of Colorectal Surgery, Mayo Clinic, Rochester, MN, United States.
Kellie L
KL
Mathis
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States.
Andrea A
AA
Gossard
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States.
Jayant A
JA
Talwalkar
College of Health Solutions, Arizona State University, Phoenix, AZ, United States. Electronic address: Keith.Lindor@asu.edu.
Keith D
KD
Lindor
D000230:Adenocarcinoma / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D001005:Anus Neoplasms / Q000453:epidemiology*; D002648:Child; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000473:pathology*; D005260:Female; D006801:Humans; D007078:Ileal Neoplasms / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
Autoimmune liver disease; Colorectal cancer; Inflammatory bowel disease