Dave Mili, Power Sydney, Herfarth Hans H, Barnes Edward L
University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Inflamm Bowel Dis. 2025 Jun 13;31(6):1514-1519. doi: 10.1093/ibd/izae175.
The value of histologic assessment after ileal pouch-anal anastomosis (IPAA) has not been definitively determined. We evaluated the correlation between histology and endoscopic findings, as well as the proportion of patients with inflammation in areas beyond the pouch body on their initial pouchoscopy after IPAA.
In a retrospective cohort study, we evaluated patients who underwent IPAA for UC between 2012 and 2020 and subsequently underwent a pouchoscopy with routine biopsies of the pouch body, pre-pouch ileum, and rectal cuff. We compared endoscopic and histologic assessments in each location using χ2 testing and Spearman correlation, as well as the development of pouchitis and Crohn's-like disease of the pouch (CLDP) in longitudinal follow-up.
Among 126 patients, the median time to pouchoscopy after IPAA was 384 days, with 82 patients (65%) having inflammation of the pouch body. Significantly more patients with pouch body inflammation had histologic inflammation compared with patients without pouch body inflammation (96% vs 22%, P < .001, r = 0.769). Additionally, 16 patients (13%) were found to have endoscopic inflammation of the pre-pouch ileum with corresponding histologic inflammation in 88%; of these, 31% later developed CLDP. In contrast, 13% of patients with no endoscopic inflammation displayed histologic inflammation, with none later developing CLDP. Forty-six percent of patients had rectal cuff inflammation (correlation with histologic inflammation r = 0.580).
In our evaluation, the added benefit of histology in the presence of visible endoscopic inflammation for disease activity assessment scores is unclear. The prognostic value of histologic inflammation without endoscopic inflammation warrants a longitudinal study.
回肠储袋肛管吻合术（IPAA）后组织学评估的价值尚未明确确定。我们评估了组织学与内镜检查结果之间的相关性，以及IPAA术后初次储袋镜检查时储袋体以外区域有炎症的患者比例。
在一项回顾性队列研究中，我们评估了2012年至2020年间因溃疡性结肠炎接受IPAA手术，随后接受储袋镜检查并对储袋体、储袋前回肠和直肠袖口进行常规活检的患者。我们使用χ2检验和Spearman相关性比较了每个部位的内镜和组织学评估结果，以及纵向随访中储袋炎和储袋克罗恩样疾病（CLDP）的发生情况。
126例患者中，IPAA术后进行储袋镜检查的中位时间为384天，82例患者（65%）储袋体有炎症。与储袋体无炎症的患者相比，储袋体有炎症的患者组织学炎症明显更多（96%对22%，P<0.001，r=0.769）。此外，16例患者（13%）储袋前回肠有内镜炎症，其中88%有相应的组织学炎症；其中31%后来发展为CLDP。相比之下，13%无内镜炎症的患者有组织学炎症，无一例后来发展为CLDP。46%的患者直肠袖口有炎症（与组织学炎症的相关性r=0.580）。
在我们的评估中，对于疾病活动度评估评分，在有可见内镜炎症的情况下组织学检查的额外益处尚不清楚。无内镜炎症的组织学炎症的预后价值值得进行纵向研究。
