Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Crohns Colitis. 2021 Aug 2;15(8):1272-1278. doi: 10.1093/ecco-jcc/jjab025.
The optimal restorative surgical management of patients with concomitant diagnoses of primary sclerosing cholangitis and ulcerative colitis [PSC-UC] who require colectomy is controversial, given that patients may have an increased risk for pouchitis after ileal pouch-anal anastomosis [IPAA]. We aimed to compare rates of pouchitis and pouch failure among patients with and without PSC by performing a systematic review and meta-analysis.
A systematic search performed through August 18, 2020, identified 12 studies that compared the rates of pouchitis [n = 11] and/or pouch failure [n = 6] among patients with PSC-UC and UC alone. We then performed a meta-analysis using random effects modelling to estimate the odds of developing any episodes of pouchitis or pouch failure.
A total of 4108 patients underwent an ileal pouch-anal anastomosis after proctocolectomy for UC. Of these, 3799 [92%] were performed for UC alone and 309 [8%] were performed for PSC-UC. In a meta-analysis of 11 studies, patients with PSC-UC compared with UC alone were significantly more likely to develop any pouchitis (63% vs 30%, odds ratio [OR] 4.21, 95% confidence interval [CI] 2.86-6.18), chronic pouchitis [47% vs 15%, OR 6.37, 95% CI 3.41-11.9], and pouch failure [10% vs 7%, OR 1.85, 95% CI 1.08-3.17].
Patients with PSC-UC were more likely to experience pouchitis and pouch failure than patients with UC alone. The risks of inflammatory complications after IPAA must be weighed against the potential complications with other surgical procedures, and future studies comparing outcomes among these procedures may inform decision making in this population.
原发性硬化性胆管炎和溃疡性结肠炎 [PSC-UC] 合并诊断的患者需要结肠切除术，其最佳修复性手术治疗存在争议，因为这些患者在接受回肠贮袋肛管吻合术 [IPAA] 后可能有更高的贮袋炎风险。我们旨在通过系统评价和荟萃分析比较 PSC 和非 PSC 患者的贮袋炎和贮袋失败率。
通过 2020 年 8 月 18 日的系统搜索，确定了 12 项比较 PSC-UC 和单纯 UC 患者的贮袋炎 [n=11] 和/或贮袋失败 [n=6] 发生率的研究。然后，我们使用随机效应模型进行荟萃分析，以估计发生任何贮袋炎或贮袋失败的几率。
共有 4108 例患者因 UC 而行直肠结肠切除术后接受回肠贮袋肛管吻合术。其中，3799 例 [92%] 为单纯 UC 患者，309 例 [8%] 为 PSC-UC 患者。在对 11 项研究的荟萃分析中，与单纯 UC 患者相比，PSC-UC 患者发生任何贮袋炎的几率明显更高（63% vs 30%，比值比 [OR] 4.21，95%置信区间 [CI] 2.86-6.18），慢性贮袋炎（47% vs 15%，OR 6.37，95% CI 3.41-11.9）和贮袋失败（10% vs 7%，OR 1.85，95% CI 1.08-3.17）。
PSC-UC 患者比单纯 UC 患者更易发生贮袋炎和贮袋失败。在 IPAA 后发生炎症并发症的风险必须与其他手术程序的潜在并发症相权衡，比较这些程序的结果的未来研究可能有助于在该人群中做出决策。
