Zemanek Mark, Westbrook Cates Katherine, Powers Joseph Carter, Dester Emma, Yang Qijun, Smith Riley, Hull Tracy, Cohen Benjamin L, Qazi Taha
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Crohns Colitis 360. 2025 Jan 23;7(1):otaf005. doi: 10.1093/crocol/otaf005. eCollection 2025 Jan.
Many patients with medically refractory ulcerative colitis undergo ileal pouch-anal anastomosis, which typically includes the creation of a temporary loop ileostomy. The impact of the interval between ileal pouch-anal anastomosis and loop ileostomy closure regarding endoscopic pouch inflammation has not been well defined. The aim for this project was to assess if delayed loop ileostomy closure increases patients' risk of endoscopic pouch inflammation.
This is a cohort study of patients with ulcerative colitis who underwent ileal pouch-anal anastomosis between 01/2010 and 12/2020. Patients were divided into groups-early (12-116 days) or late closure (>180 days)-based on interval between ileal pouch-anal anastomosis and loop ileostomy closure. The late closure group was further sub-divided by indication for delay which included post-operative complications and non-medical reasons. The primary outcome was development of endoscopic inflammatory pouch disease, which was a composite of pouch disease activity index score of ≥ 4, mucosal breaks beyond anastomotic lines, and diffuse pouch inflammation.
Two-hundred ninety patients were included which comprised early and late cohorts of 217 and 73 patients, respectively. Compared to early closure, late closures for non-medical and pouch-related surgical complications were both not found to be associated with development of our composite outcome ( = .43 and = .80, respectively).
Delaying ileostomy closure due to patient preference or logistical limitations did not result in an increased risk of endoscopic pouch inflammation, but there appears to be an association of extraintestinal manifestations with endoscopic inflammatory pouch disease, suggesting the need for a vigilant surveillance in these patients.
许多药物治疗无效的溃疡性结肠炎患者接受回肠储袋肛管吻合术，该手术通常包括创建一个临时的回肠袢式造口术。回肠储袋肛管吻合术与回肠袢式造口术关闭之间的间隔时间对内镜下储袋炎症的影响尚未明确。本项目的目的是评估延迟关闭回肠袢式造口术是否会增加患者内镜下储袋炎症的风险。
这是一项对2010年1月至2020年12月期间接受回肠储袋肛管吻合术的溃疡性结肠炎患者的队列研究。根据回肠储袋肛管吻合术与回肠袢式造口术关闭之间的间隔时间，将患者分为早期（12 - 116天）或晚期关闭（>180天）两组。晚期关闭组根据延迟的原因进一步细分，包括术后并发症和非医疗原因。主要结局是内镜下炎症性储袋疾病的发生，其为储袋疾病活动指数评分≥4、吻合口线以外的黏膜破损和弥漫性储袋炎症的综合表现。
共纳入290例患者，分别组成早期队列（217例）和晚期队列（73例）。与早期关闭相比，因非医疗和储袋相关手术并发症导致的晚期关闭均未发现与我们的综合结局的发生相关（分别为P = 0.43和P = 0.80）。
由于患者偏好或后勤限制而延迟关闭回肠造口术不会导致内镜下储袋炎症风险增加，但肠外表现似乎与内镜下炎症性储袋疾病有关，这表明需要对这些患者进行密切监测。
