Cuffitis linked to anastomosis, diffuse inflammation and pouch excision
AUSTIN, Texas — An initial analysis of postoperative pouchitis phenotypes linked cuffitis to independent variables, according to a presenter at the Crohn’s and Colitis Congress.
“Cuffitis can involve the anastomosis and develop diffuse inflammation of the pouch,” Shintaro Akiyama, MD, PhD, MSc, IBD fellow at the University of Chicago, said during his presentation. “Cuffitis is significantly associated with pouch excision and it is a promising target to improve the outcome of pouchitis.”
Though pouchitis can develop in up to 80% of patients after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA), Akiyama said endoscopic phenotypes have not yet been clarified. He and his colleagues sought to establish a database of endoscopic findings of pouchitis.
In this retrospective chart review, the researchers found 426 patients who underwent 1,195 endoscopies (2.8 scopes per patient). They assessed the data for contributing factors and prognosis of each phenotype.
In this report, Akiyama presented results of contributing factors and prognosis of J-pouch with cuffitis. They compared patients with normal cuff (n = 208) to those with cuffitis (n = 73) noted in every pouchoscopy.
They found three variables associated with cuffitis: 3-stage IPAA (P = .01), stapled anastomosis (P < .001) and preoperative anti-TNF medication (P = .011). In looking at the endoscopic data, Akiyama showed three variables were again associated with cuffitis: diffuse inflammation of the pouch (P = .003), anastomosis involvement (P < .001) and pouch excision (P = .035).
After logistic regression analysis, the researchers found that any involvement of anastomosis (stapled anastomosis, P < .001; anastomosis involvement, P < .001) and diffuse inflammation (P = .041) linked to cuffitis.
“Our analysis demonstrated the association of a particular endoscopic phenotype of the pouch and its prognosis,” Akiyama said. – by Katrina Altersitz
Reference: Akiyama K, et al. Abstract 24. Presented at: Crohn’s and Colitis Congress; Jan. 23-25, 2020; Austin, Texas.
Disclosures: Healio Gastroenterology and Liver Disease could not confirm the authors relevant financial disclosures prior to publication.