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Crohn's disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure.
Dis Colon Rectum. 2005 Aug; 48(8):1542-9.DC

Abstract

PURPOSE

This study was designed to determine the outcome of patients with Crohn's disease and indeterminate colitis who have an ileal pouch-anal anastomosis.

METHODS

Between 1982 and 2001, 1,270 patients underwent a restorative proctocolectomy at the Mount Sinai Hospital: 1,135 had ulcerative colitis, 36 had Crohn's disease, 21 had indeterminate colitis, and 78 had another diagnosis. Perioperative data were collected prospectively. Functional outcomes were assessed with a 35-question survey mailed to all patients with a functioning pouch of at least six months duration.

RESULTS

Pouch complications were significantly more common in patients with Crohn's disease (64 percent) and indeterminate colitis (43 percent) compared with patients with ulcerative colitis (22 percent) (P < 0.05). Similarly, 56 percent of patients with Crohn's disease had their pouch excised or defunctioned, compared with 10 percent of patients with indeterminate colitis and 6 percent with ulcerative colitis (P < 0.01). In the subgroup of patients with a diagnosis of Crohn's disease, multivariate analysis revealed that the pathologist's initial designation of ulcerative colitis (based on the colectomy specimen) and an increasing number of pathologic, clinical, and endoscopic features of Crohn's disease were independently associated with pouch failure. The functional results in patients with Crohn's disease with a successful pouch were not significantly different from those with indeterminate colitis or ulcerative colitis.

CONCLUSIONS

Although complication rates may be higher in patients with indeterminate colitis compared with ulcerative colitis, the overall pouch failure rate is similar. On the other hand, more than one-half of patients with Crohn's disease will require pouch excision or diversion. Our data suggest that it is difficult to identify patients with Crohn's disease who are likely to have a successful outcome after restorative proctocolectomy. Thus, Crohn's disease should remain a relative contraindication to restorative proctocolectomy, whereas ileal pouch-anal anastomosis is an acceptable alternative for patients with indeterminate colitis.

Authors+Show Affiliations

Brown CJ
IBD Research Unit, Mount Sinai Hospital, Toronto, Ontario, Canada.
Maclean AR
No affiliation info available
Cohen Z
No affiliation info available
Macrae HM
No affiliation info available
O'Connor BI
No affiliation info available
McLeod RS
No affiliation info available

MeSH

AdultAnastomosis, SurgicalColitisColitis, UlcerativeColonic PouchesCrohn DiseaseFemaleFollow-Up StudiesHumansIleostomyMalePatient SatisfactionPostoperative ComplicationsProctocolectomy, RestorativeProspective StudiesQuality of LifeReoperationTreatment FailureTreatment Outcome

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15937625

Citation

Brown, Carl J., et al. "Crohn's Disease and Indeterminate Colitis and the Ileal Pouch-anal Anastomosis: Outcomes and Patterns of Failure." Diseases of the Colon and Rectum, vol. 48, no. 8, 2005, pp. 1542-9.
Brown CJ, Maclean AR, Cohen Z, et al. Crohn's disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure. Dis Colon Rectum. 2005;48(8):1542-9.
Brown, C. J., Maclean, A. R., Cohen, Z., Macrae, H. M., O'Connor, B. I., & McLeod, R. S. (2005). Crohn's disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure. Diseases of the Colon and Rectum, 48(8), 1542-9.
Brown CJ, et al. Crohn's Disease and Indeterminate Colitis and the Ileal Pouch-anal Anastomosis: Outcomes and Patterns of Failure. Dis Colon Rectum. 2005;48(8):1542-9. PubMed PMID: 15937625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Crohn's disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure. AU - Brown,Carl J, AU - Maclean,Anthony R, AU - Cohen,Zane, AU - Macrae,Helen M, AU - O'Connor,Brenda I, AU - McLeod,Robin S, PY - 2005/6/7/pubmed PY - 2005/9/2/medline PY - 2005/6/7/entrez SP - 1542 EP - 9 JF - Diseases of the colon and rectum JO - Dis Colon Rectum VL - 48 IS - 8 N2 - PURPOSE: This study was designed to determine the outcome of patients with Crohn's disease and indeterminate colitis who have an ileal pouch-anal anastomosis. METHODS: Between 1982 and 2001, 1,270 patients underwent a restorative proctocolectomy at the Mount Sinai Hospital: 1,135 had ulcerative colitis, 36 had Crohn's disease, 21 had indeterminate colitis, and 78 had another diagnosis. Perioperative data were collected prospectively. Functional outcomes were assessed with a 35-question survey mailed to all patients with a functioning pouch of at least six months duration. RESULTS: Pouch complications were significantly more common in patients with Crohn's disease (64 percent) and indeterminate colitis (43 percent) compared with patients with ulcerative colitis (22 percent) (P < 0.05). Similarly, 56 percent of patients with Crohn's disease had their pouch excised or defunctioned, compared with 10 percent of patients with indeterminate colitis and 6 percent with ulcerative colitis (P < 0.01). In the subgroup of patients with a diagnosis of Crohn's disease, multivariate analysis revealed that the pathologist's initial designation of ulcerative colitis (based on the colectomy specimen) and an increasing number of pathologic, clinical, and endoscopic features of Crohn's disease were independently associated with pouch failure. The functional results in patients with Crohn's disease with a successful pouch were not significantly different from those with indeterminate colitis or ulcerative colitis. CONCLUSIONS: Although complication rates may be higher in patients with indeterminate colitis compared with ulcerative colitis, the overall pouch failure rate is similar. On the other hand, more than one-half of patients with Crohn's disease will require pouch excision or diversion. Our data suggest that it is difficult to identify patients with Crohn's disease who are likely to have a successful outcome after restorative proctocolectomy. Thus, Crohn's disease should remain a relative contraindication to restorative proctocolectomy, whereas ileal pouch-anal anastomosis is an acceptable alternative for patients with indeterminate colitis. SN - 0012-3706 UR - https://www.unboundmedicine.com/medline/citation/15937625/Crohn's_disease_and_indeterminate_colitis_and_the_ileal_pouch_anal_anastomosis:_outcomes_and_patterns_of_failure_ DB - PRIME DP - Unbound Medicine ER -