Lo Sheng Wei, Dharia Ishaan, Sriranganathan Danujan, Kayal Maia, Barnes Edward L, Segal Jonathan P
Department of Gastroenterology, Northern Hospital, Epping, Australia.
Department of Gastroenterology, The Mount Sinai Hospital, New York, NY, USA.
Intest Res. 2025 Jan;23(1):56-64. doi: 10.5217/ir.2024.00009. Epub 2024 Aug 9.
BACKGROUND/AIMS: One complication of restorative proctocolectomy with ileo-anal pouch anastomosis is fistula formation in the pouch. Fistulas can be associated with significant morbidity and pouch failure. We conducted a systematic review with meta- analysis to try and understand the prevalence of pouch fistulas in patients with ulcerative colitis following restorative proctocolectomy.
The Embase, Embase Classic, and PubMed databases were searched between January 1979 and April 2022. Studies were included if there were cross-sectional, case-controlled, population-based or cohort studies reporting on prevalence of pouch fistulas in ulcerative colitis. Studies had to report the number of patients with pouch fistulas using either clinical, endoscopic, or radiological diagnosis in an adult population.
Thirty-three studies screened met the inclusion criteria. The pooled prevalence of developing at least 1 fistula was 0.05 (95% confidence interval [CI], 0.04-0.07). The pooled prevalence of pouch failure in patients with pouch fistula was found to be 0.24 (95% CI, 0.19-0.30). The pooled prevalence of developing a pouch fistula at 3 years, 5 years and more than 5 years was 0.04 (95% CI, 0.02-0.07), 0.05 (95% CI, 0.02-0.07), and 0.05 (95% CI, 0.02-0.10), respectively.
This is the first systematic review and meta-analysis to report the prevalence of pouch fistula. It also provides a pooled prevalence of pouch failure in these patients. These results can help to shape future guidelines, power future studies, and help counsel patients.
背景/目的：回肠肛管袋状吻合术式的全直肠系膜切除术的一个并发症是在袋囊中形成瘘管。瘘管可能与严重的发病率和袋囊功能衰竭相关。我们进行了一项系统评价和荟萃分析，以试图了解溃疡性结肠炎患者在接受全直肠系膜切除术后袋囊瘘管的发生率。
检索了1979年1月至2022年4月期间的Embase、Embase经典版和PubMed数据库。纳入的研究需为横断面研究、病例对照研究、基于人群的研究或队列研究，报告溃疡性结肠炎患者袋囊瘘管的发生率。研究必须报告使用临床、内镜或放射学诊断方法在成年人群中发现的袋囊瘘管患者数量。
筛选出的33项研究符合纳入标准。至少发生1例瘘管的合并发生率为0.05（95%置信区间[CI]，0.04 - 0.07）。发现有袋囊瘘管的患者中袋囊功能衰竭的合并发生率为0.24（95%CI，0.19 - 0.30）。3年、5年和5年以上发生袋囊瘘管的合并发生率分别为0.04（95%CI，0.02 - 0.07）、0.05（95%CI，0.02 - 0.07）和0.05（95%CI，0.02 - 0.10）。
这是首次报告袋囊瘘管发生率的系统评价和荟萃分析。它还提供了这些患者袋囊功能衰竭的合并发生率。这些结果有助于制定未来的指南、为未来的研究提供统计学效力，并帮助为患者提供咨询。
