title: Large bowel mucosal neoplasia in the original specimen may increase the risk of ileal pouch neoplasia in patients following restorative proctocolectomy for ulcerative colitis.
abstract: OBJECTIVE
  Restorative proctocolectomy is a current gold standard procedure for patients who require a colectomy for ulcerative colitis. The incidence of ileal pouch neoplasia is low. The aims of this study were to assess the prevalence of neoplasia in ileal pouch and investigate the risk factors for ileal pouch neoplasia.
  
  
  METHODS
  A total of 276 patients who underwent restorative proctocolectomy for ulcerative colitis between 1984 and 2009 were analyzed. Results of histological examinations of both original specimen and biopsies from the J-pouch taken during routine pouch endoscopy were evaluated. Patients' records were analyzed for ulcerative colitis duration, the time from pouch creation to pouch neoplasia, presence of pouchitis, as well as the concurrent primary sclerosing cholangitis.
  
  
  RESULTS
  Analyzing the original specimen of large bowel, fifty-six lesions of low-grade dysplasia, twenty-five high-grade dysplasia, and five adenocarcinoma were revealed. All patients with dysplasia (n = 8) or adenocarcinoma (n = 1) of the J-pouch were positive for dysplasia in the original specimen. Duration of ulcerative colitis before surgery and duration time following restorative proctocolectomy were found as risk factors for J-pouch neoplasia with a significant difference (p = 0.01 and p = 0.0003, respectively). Patients with pouch neoplasia developed significantly more severe pouchitis (p = 0.00001).
  
  
  CONCLUSIONS
  Neoplasia of the J-pouch is rare. Patients with neoplasia in the original specimen are more susceptible to develop neoplasia in the J-pouch. Precise follow-up in patients with neoplasia lesions in the original specimen should be recommended. Moreover, in patients with risk factors, the exact surveillance pouch endoscopy should be recommended.
authors.affiliation: Department of General, Endocrinological and Gastroenterological Oncological Surgery, Poznań University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland, bobofon007@gmail.com.
authors.forename: Adam
authors.initials: A
authors.lastname: Bobkiewicz
authors.forename: Lukasz
authors.initials: L
authors.lastname: Krokowicz
authors.forename: Jacek
authors.initials: J
authors.lastname: Paszkowski
authors.forename: Adam
authors.initials: A
authors.lastname: Studniarek
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Szmyt
authors.forename: Jan
authors.initials: J
authors.lastname: Majewski
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Walkowiak
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Majewski
authors.forename: Michal
authors.initials: M
authors.lastname: Drews
authors.forename: Tomasz
authors.initials: T
authors.lastname: Banasiewicz
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D003093:Colitis, Ulcerative / Q000473:pathology* / Q000601:surgery; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D039021:Colonic Pouches / Q000473:pathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000473:pathology; D015995:Prevalence; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D013997:Time Factors