St. Mark's Hospital, Harrow, United Kingdom.
Department of Surgery and Cancer, Imperial College, London, United Kingdom.
Dis Colon Rectum. 2018 Apr;61(4):472-475. doi: 10.1097/DCR.0000000000000978.
Restorative proctocolectomy is the procedure of choice in patients with ulcerative colitis refractory to medical therapy. Prepouch ileitis is characterized by mucosal inflammation immediately proximal to the pouch. Prepouch ileitis is uncommon, and long-term follow-up data are lacking.
The aim of this study is to report the long-term outcomes of prepouch ileitis.
We followed up a cohort of patients with prepouch ileitis that was originally described in 2009. Patients were followed up until the last recorded clinic attendance or at the point of pouch failure. Follow-up data collected included stool frequency, endoscopic findings, treatment, and overall pouch function.
We accessed a prospectively maintained database at our institution between January 2009 and January 2017.
Three of the 34 patients originally described in 2009 were lost to follow-up; we reanalyzed data on the remaining 31.
The rate of pouch failure was defined as the need for ileostomy or pouch revision.
All 31 patients had coexisting pouchitis at index diagnosis of prepouch ileitis. The median length of follow-up from the index pouchoscopy was 98 (range, 27-143) months. Seven (23%) patients who had an index pouchoscopy with prepouch ileitis went on to pouch failure, which is significantly higher than expected (p = 0.03). Five (71%) of these patients had chronic pouchitis, and 2 (29%) had small-bowel obstruction due to prepouch stricture. Two patients had evidence that would support possible Crohn's disease at long-term follow-up.
This was a retrospective analysis. Because of the nature of the study, there was some missing information that may have influenced the results. Our study is further limited by small patient numbers.
Prepouch ileitis is associated with a significantly increased risk of pouch failure compared with the overall reported literature for restorative proctocolectomy. Prepouch ileitis does not appear to be strongly predictive of Crohn's disease at long-term follow-up. See Video Abstract at http://links.lww.com/DCR/A480.
对于药物治疗无效的溃疡性结肠炎患者，选择行直肠结肠切除术。吻合口附近肠炎的特点是吻合口近端黏膜炎症。吻合口附近肠炎并不常见，且缺乏长期随访数据。
本研究旨在报告吻合口附近肠炎的长期结果。
我们对最初于 2009 年描述的吻合口附近肠炎患者队列进行了随访。患者的随访时间截至最后一次记录的就诊或吻合口失败。收集的随访数据包括粪便频率、内镜发现、治疗和总体吻合口功能。
我们在 2009 年 1 月至 2017 年 1 月期间从我们的机构中获取了一个前瞻性维护的数据库。
最初于 2009 年描述的 34 例患者中有 3 例失访；我们重新分析了其余 31 例患者的数据。
吻合口失败的发生率定义为需要行回肠造口术或吻合口修正术。
所有 31 例患者在吻合口附近肠炎首次诊断时均伴有吻合口结肠炎。从首次吻合口内镜检查到随访的中位时间为 98（范围，27-143）个月。7（23%）例在首次吻合口内镜检查时存在吻合口附近肠炎的患者随后出现吻合口失败，显著高于预期（p = 0.03）。这些患者中有 5（71%）例患有慢性吻合口结肠炎，2（29%）例因吻合口狭窄而出现小肠梗阻。2 例患者在长期随访中存在支持可能的克罗恩病的证据。
这是一项回顾性分析。由于研究的性质，存在一些可能影响结果的缺失信息。我们的研究还受到患者数量少的限制。
与直肠结肠切除术的总体报告文献相比，吻合口附近肠炎与吻合口失败的风险显著增加相关。在长期随访中，吻合口附近肠炎似乎不能强烈预测克罗恩病。
