AIM:To investigate the outcomes of treatments for complications after ileal pouch-anal anastomosis(IPAA)in Korean patients with ulcerative colitis.METHODS:Between March 1998 and February 2013,72 patients(28 male and 4...AIM:To investigate the outcomes of treatments for complications after ileal pouch-anal anastomosis(IPAA)in Korean patients with ulcerative colitis.METHODS:Between March 1998 and February 2013,72 patients(28 male and 44 female,median age 43.0years±14.0 years)underwent total proctocolectomy with IPAA.The study cohort was registered prospectively and analyzed retrospectively.Patient characteristics,medical management histories,operative findings,pathology reports and postoperative clinical courses,including early postoperative and late complications and their treatments,were reviewed from a medical record system.All of the ileal pouches were J-pouch and were performed with either the double-stapling technique(n=69)or a hand-sewn(n=3)technique.RESULTS:Thirty-one(43.1%)patients had early complications,with 12(16.7%)patients with complications related to the pouch.Pouch bleeding,pelvic abscesses and anastomosis ruptures were managed conservatively.Patients with pelvic abscesses were treated with surgical drainage.Twenty-seven(38.0%)patients had late complications during the follow-up period(82.5±50.8 mo),with 21(29.6%)patients with complications related to the pouch.Treatment for pouchitis included antibiotics or anti-inflammatory drugs.Pouch-vaginal fistulas,perianal abscesses or fistulas and anastomosis strictures were treated surgically.Pouch failure developed in two patients(2.8%).Analyses showed that an emergency operation was a significant risk factor for early pouch-related complications compared to elective procedures(55.6%vs 11.1%,P<0.05).Pouchitis was related to early(35.3%)and the other late pouch-related complications(41.2%)(P<0.05).The complications did not have an effect on pouch failure nor pouch function.CONCLUSION:The complications following IPAA can be treated successfully.Favorable long-term outcomes were achieved with a lower pouch failure rate than reported in Western patients.展开更多
We report on a patient diagnosed with PeutzJeghers syndrome(PJS) with synchronous rectal cancer who was treated with laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA). PJS is an autosoma...We report on a patient diagnosed with PeutzJeghers syndrome(PJS) with synchronous rectal cancer who was treated with laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA). PJS is an autosomal dominant syndrome characterized by multiple hamartomatous polyps in the gastrointestinal tract, mucocutaneous pigmentation, and increased risks of gastrointestinal and nongastrointestinal cancer. This report presents a patient with a 20-year history of intermittent bloody stool, mucocutaneous pigmentation and a family history of PJS, which together led to a diagnosis of PJS. Moreover, colonoscopy and biopsy revealed the presence of multiple serried giant pedunculated polyps and rectal adenocarcinoma. Currently, few options exist for the therapeutic management of PJS with synchronous rectal cancer. For this case, we adopted an unconventional surgical strategy and ultimately performed laparoscopic restorative proctocolectomy with IPAA. This procedure is widely considered to be the first-line treatment option for patients with ulcerative colitis or familial adenomatous polyposis. However, there are no previous reports of treating PJS patients with laparoscopic IPAA. Since the operation, the patient has experienced no further episodes of gastrointestinal bleeding and has demonstrated satisfactory bowel control. Laparoscopic restorative proctocolectomy with IPAA may be a safe and effective treatment for patients with PJS with synchronous rectal cancer.展开更多
AIM To assess the therapeutic potential of Lactobacillus acidophilus(LA) for the treatment of pouchitis in a rat model.METHODS Sprague Dawley rats underwent proctocolectomy and ileal pouch-anal anastomosis followed by...AIM To assess the therapeutic potential of Lactobacillus acidophilus(LA) for the treatment of pouchitis in a rat model.METHODS Sprague Dawley rats underwent proctocolectomy and ileal pouch-anal anastomosis followed by administration of dextran sulfate sodium(DSS) to induce pouchitis. Rats with pouchitis were randomly divided into three groups: no intervention(NI), normal saline(NS, 3 m L/d normal saline for 7 d), and LA(3 m L/d LA at 1× 1010 colony-forming units for 7 d). General body condition was recorded and pouch specimens were obtained for histological examination. m RNA expression levels of interleukin(IL)-1β, IL-6, IL-10, and tumor necrosis factor-α were determined by RT-PCR. Zonula occludens protein 1(ZO-1) levels were measured by immunohistochemistry. RESULTS LA reduced weight loss associated with pouchitis(P < 0.05) and improved the symptoms of pouchitis in rats. Compared with the NI and NS groups, rats in the LAgroup showed earlier disappearance of hematochezia(6.17 ± 0.75, 6.50 ± 0.55, 3.17 ± 0.75, P < 0.05) and higher fecal scores(2.67 ± 0.48, 2.50 ± 0.51, 4.42 ± 0.50, respectively, P < 0.05). Histological scores were also lower in the LA group compared with the other two groups(7.17 ± 0.98, 8.00 ± 0.89, 4.00 ± 0.89, respectively, P < 0.05). m RNA expression levels of IL-1β, IL-6, and tumor necrosis factor-α were significantly reduced, while IL-10 m RNA levels were significantly increased in the LA group(P < 0.05, respectively). ZO-1 protein levels were also significantly increased after administration of LA(P < 0.05). CONCLUSION LA alleviates pouchitis induced by DSS after ileal pouchanal anastomosis by decreasing pro-inflammatory factors and increasing anti-inflammatory factors, and restoring ZO-1 expression in the mucosa.展开更多
Total proctocolectomy with ileal pouch-anal anastomosis(IPAA) is the current gold standard in the surgical treatment of ulcerative colitis(UC) refractory to medical management. A procedure of significant magnitude car...Total proctocolectomy with ileal pouch-anal anastomosis(IPAA) is the current gold standard in the surgical treatment of ulcerative colitis(UC) refractory to medical management. A procedure of significant magnitude carries its own risks including anastomotic failure, pelvic sepsis and a low rate of neoplastic degeneration overtime. Recent studies have shown that total colectomy with ileorectal anastomosis(IRA) has been associated with good long-term functional results in a selected group of UC patients amenable to undergo a strict surveillance for the relatively high risk of cancer in the rectum. This manuscript will review and compare the most recent literature on IRA and IPAA as it pertains to postoperative morbidity and mortality, failure rates, functional outcomes and cancer risk.展开更多
Restorative proctocolectomy with ileal pouch-anal anastomosis(RP-IPAA) is the gold standard surgical treatment for ulcerative colitis.However,despite the widespread use of RP-IPAA,many aspects of this treatment still ...Restorative proctocolectomy with ileal pouch-anal anastomosis(RP-IPAA) is the gold standard surgical treatment for ulcerative colitis.However,despite the widespread use of RP-IPAA,many aspects of this treatment still remain controversial,such as the approach(open or laparoscopic),number of stages in the surgery,type of pouch,and construction type(hand-sewn or stapled ileal pouch-anal anastomosis).The present narrative review aims to discuss current evidence on the short-,mid-,and long-term results of each of these technical alternatives as well as their benefits and disadvantages.A review of the MEDLINE,EMBASE,and Ovid databases was performed to identify studies published through March 2016.Few large,randomized,controlled studies have been conducted,which limits the conclusions that can be drawn regarding controversial issues.The available data from retrospective studies suggest that laparoscopic surgery has no clear advantages compared with open surgery and that one-stage RP-IPAA may be indicated in selected cases.Regarding 2- and 3-stage RP-IPAA,patients who underwent these surgeries differed significantly with respect to clinical and laboratory variables,making any comparisons extremely difficult.The long-term results regarding the pouch type show that the W- and J-reservoirs do not differ significantly,although the J pouch is generally preferred by surgeons.Hand-sewn and stapled ileal pouch-anal anastomoses have their own advantages,and there is no clear benefit of one technique over the other.展开更多
Primary pouchitis is a common complication of ileal pouch-anal anastomosis following proctocolectomy in patients treated for ulcerative colitis (UC), but is un-usual for those treated for familial adenomatous polyposi...Primary pouchitis is a common complication of ileal pouch-anal anastomosis following proctocolectomy in patients treated for ulcerative colitis (UC), but is un-usual for those treated for familial adenomatous polyposis (FAP). While a number of theories as to the pathogenesis of this inflammatory condition have been proposed, no single one has been wholly satis-factory. Much research has been devoted to investi-gating a link between the pathogenic factors involved in UC, but not FAP, and those underlying pouchitis. The contribution of sulfate-producing bacteria has also been explored. The role of other intraluminal factors, such as short chain fatty acids and unconju-gated bile salts, has also been investigated. A unifying theory of a multi-step process might explain the pathogenesis of pouchitis, but further research is re-quired to proof causation. It is likely that pouchitis develops as a result of a combination of genetic, im-munological, microbial and metabolic factors. Future insight into the causes of pouchitis may eventually allow for the development of more effective treat-ments.展开更多
Background The incidence of chronic ulcerative colitis (CUC) in China is remarkably increasing, while little information on surgical treatment has been reported. This study aimed to completely describe and analyze t...Background The incidence of chronic ulcerative colitis (CUC) in China is remarkably increasing, while little information on surgical treatment has been reported. This study aimed to completely describe and analyze the clinical outcome of restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA)for CUC in China. Methods Ninety-five consecutive patients, who suffered CUC and had surgical indications, were carefully selected. All patients underwent IPAA. Data on patient characteristics, surgical indications, surgical details, postoperative complications, functional outcome, and quality of life were collected. Results The mean patient age at the time of the operation was 32 years. Twenty-nine (31%) patients underwent an emergency operation, and 66 (69%) underwent elective procedures. Four patients with severe dysplasia underwent operations, but no carcinoma was histologically confirmed. A two-stage operation was performed in 87 (92%) patients, and a hand-sewn technique was applied in 88 (93%) patients. Sixteen patients (17.0%) experienced early complications, and there was a significant difference between the emergency surgery group and the elective group (31.0% vs. 10.6%, respectively; P 〈0.01). Five (5.3%) patients developed pouchitis as a late complication. The mean stool frequency after the operation was 4.6 (2-11) during the first 24 hours and 1.5 (0-4) overnight. According to the Kirwan grading scale, 87 (91.8%) patients showed satisfactory anal continence function. The quality of life improved significantly from a preoperative mean value of 0.28-0.61 before ileostomy closure to 0.78 after ileostomy closure (P 〈0.01) according to the Cleveland Global Quality of Life index. Conclusions IPAA is an effective and safe surgical procedure for patients with CUC in China. However, some characteristics, such as the low incidence of pouchitis, require further study.展开更多
Restorative proctocolectomy is the most common surgical option for patients with familial adenomatous polyposis(FAP). However,adenomas may develop in the ileal pouch mucosa over time,and even carcinoma in the pouch ha...Restorative proctocolectomy is the most common surgical option for patients with familial adenomatous polyposis(FAP). However,adenomas may develop in the ileal pouch mucosa over time,and even carcinoma in the pouch has been reported. We therefore reviewed the prevalence,nature,and treatment of adenomas and carcinoma that develop after proctocolectomy in the ileal pouch mucosa in patients with FAP. In 25 reports that were reviewed,the incidence of adenomas in the ileal pouch varied from 6.7% to 73.9%. Several potential factors that favor the development of pouch polyposis have been investigated,but many remain controversial. Nevertheless,it seems certain that the age of the pouch is important. The risk appears to be 7%to 16% after 5 years,35% to 42% after 10 years,and75% after 15 years. On the other hand,only 21 cases of ileal pouch carcinoma have been recorded in the literature to date. The diagnosis of pouch carcinoma was made between 3 to 20 years(median,10 years) after pouch construction. Although the risk of malignant transformation in ileal pouches is probably low,it is not negligible,and the long-term risk cannot presently be well quantified. Regular endoscopic surveillance,especially using chromoendoscopy,is recommended.展开更多
AIM:To evaluate if 3 mo oral supplementation with Eviendep was able to reduce the number of duodenal polyps in familial adenomatous polyposis(FAP)patients with ileal pouch-anal anastomosis(IPAA).METHODS:Eleven FAP pat...AIM:To evaluate if 3 mo oral supplementation with Eviendep was able to reduce the number of duodenal polyps in familial adenomatous polyposis(FAP)patients with ileal pouch-anal anastomosis(IPAA).METHODS:Eleven FAP patients with IPAA and duodenal polyps were enrolled.They underwent upper gastrointestinal(GI)endoscopy at the baseline and after 3 mo of treatment.Each patient received 5 mg Eviendep twice a day,at breakfast and dinner time,for3 mo.Two endoscopists evaluated in a blinded manner the number and size of duodenal polyps.Upper GI endoscopies with biopsies were performed at the baseline(T0)with the assessment of the Spigelman score.Polyps>10 mm were removed during endoscopy and at the end of the procedure a new Spigelman score was determined(T1).The procedure was repeated 3 mo after the baseline(T2).Four photograms were examined for each patient,at T1 and T2.The examined area was divided into 3 segments:duodenal bulb,second and third portion duodenum.Biopsy specimens were taken from all polyps>10 mm and from all suspicious ones,defined by the presence of a central depression,irregular surface,or irregular vascular pattern.Histology was classified according to the updated Vienna criteria.RESULTS:At baseline the mean number of duodenal detected polyps was 27.7 and mean sizes were 15.8mm;the mean Spigelman score was 7.1.After polypectomy the mean number of duodenal detected polyps was 25.7 and mean sizes were 7.6 mm;the mean Spigelman score was 6.4.After 3 mo of Eviendep bid,all patients showed a reduction of number and size of duodenal polyps.The mean number of duodenal polyps was 8(P=0.021)and mean size was 4.4 mm;the mean Spigelman score was 6.6.Interrater agreement was measured.Lesions>1 cm found a very good degree of concordance(kappa 0.851)and a good concordance was as well encountered for smaller lesions(kappa 0.641).CONCLUSION:Our study demonstrated that shortterm(90 d)supplementation with Eviendep in FAP patients with IPAA and with recurrent adenomas in the duodenal mucosa,resulted effective in reducing polyps number of 32%and size of 51%.展开更多
The introduction of wireless capsule endoscopy in 2000 has revolutionized our ability to visualize parts of the small bowel mucosa classically unreached by the conventional endoscope, and since the recent introduction...The introduction of wireless capsule endoscopy in 2000 has revolutionized our ability to visualize parts of the small bowel mucosa classically unreached by the conventional endoscope, and since the recent introduction of colon capsule endoscopy, a promising alternative method has been available for the evaluation of large bowel mucosa. The advantages of wireless capsule endoscopy include its non-invasive character and its ability to visualize proximal and distal parts of the intestine, while important disadvantages include the procedure's inability of tissue sampling and significant incompletion rate. Its greatest limitation is the prohibited use in cases of known or suspected stenosis of the intestinal lumen due to high risk of retention. Wireless capsule endoscopy plays an important role in the early recognition of recurrence, on Crohn's disease patients who have undergone ileocolonic resection for the treatment of Crohn's disease complications, and in patients' management and therapeutic strategy planning, before obvious clinical and laboratory relapse. Although capsule endoscopy cannot replace traditional endoscopy, it offers valuable information on the evaluation of intestinal disease and has a significant impact on disease reclassification of patients with a previous diagnosis of ulcerative colitis or inflammatory bowel disease unclassified/indeterminate colitis. Moreover, it may serve as an effective alternative where colonoscopy is contraindicated and in cases with incomplete colonoscopy studies. The use of patency capsule maximizes safety and is advocated in cases of suspected small or large bowel stenosis.展开更多
Pouchitis is not a rare complication that develops after an ileal-pouch anastomosis, performed after colectomy in patients refractory to treatment or with complicated ulcerative colitis. This condition may become chro...Pouchitis is not a rare complication that develops after an ileal-pouch anastomosis, performed after colectomy in patients refractory to treatment or with complicated ulcerative colitis. This condition may become chronic and unresponsive to medical therapies, including corticosteroids, antibiotics and probiotics. The advent of biological therapies(tumor necrosis factor-α inhibitors) has changed the course of these complications. In particular, in these cases, infliximab(IFX) may represent a safe and effective therapy in order to avoid the subsequent operation for a permanent ileostomy. This article reviews the therapeutic effects of one of the most widely used anti-tumor necrosis factor-α molecules, IFX, for the treatment of complicated pouchitis(refractory to conventional treatment and/or fistulizing).展开更多
文摘AIM:To investigate the outcomes of treatments for complications after ileal pouch-anal anastomosis(IPAA)in Korean patients with ulcerative colitis.METHODS:Between March 1998 and February 2013,72 patients(28 male and 44 female,median age 43.0years±14.0 years)underwent total proctocolectomy with IPAA.The study cohort was registered prospectively and analyzed retrospectively.Patient characteristics,medical management histories,operative findings,pathology reports and postoperative clinical courses,including early postoperative and late complications and their treatments,were reviewed from a medical record system.All of the ileal pouches were J-pouch and were performed with either the double-stapling technique(n=69)or a hand-sewn(n=3)technique.RESULTS:Thirty-one(43.1%)patients had early complications,with 12(16.7%)patients with complications related to the pouch.Pouch bleeding,pelvic abscesses and anastomosis ruptures were managed conservatively.Patients with pelvic abscesses were treated with surgical drainage.Twenty-seven(38.0%)patients had late complications during the follow-up period(82.5±50.8 mo),with 21(29.6%)patients with complications related to the pouch.Treatment for pouchitis included antibiotics or anti-inflammatory drugs.Pouch-vaginal fistulas,perianal abscesses or fistulas and anastomosis strictures were treated surgically.Pouch failure developed in two patients(2.8%).Analyses showed that an emergency operation was a significant risk factor for early pouch-related complications compared to elective procedures(55.6%vs 11.1%,P<0.05).Pouchitis was related to early(35.3%)and the other late pouch-related complications(41.2%)(P<0.05).The complications did not have an effect on pouch failure nor pouch function.CONCLUSION:The complications following IPAA can be treated successfully.Favorable long-term outcomes were achieved with a lower pouch failure rate than reported in Western patients.
文摘We report on a patient diagnosed with PeutzJeghers syndrome(PJS) with synchronous rectal cancer who was treated with laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA). PJS is an autosomal dominant syndrome characterized by multiple hamartomatous polyps in the gastrointestinal tract, mucocutaneous pigmentation, and increased risks of gastrointestinal and nongastrointestinal cancer. This report presents a patient with a 20-year history of intermittent bloody stool, mucocutaneous pigmentation and a family history of PJS, which together led to a diagnosis of PJS. Moreover, colonoscopy and biopsy revealed the presence of multiple serried giant pedunculated polyps and rectal adenocarcinoma. Currently, few options exist for the therapeutic management of PJS with synchronous rectal cancer. For this case, we adopted an unconventional surgical strategy and ultimately performed laparoscopic restorative proctocolectomy with IPAA. This procedure is widely considered to be the first-line treatment option for patients with ulcerative colitis or familial adenomatous polyposis. However, there are no previous reports of treating PJS patients with laparoscopic IPAA. Since the operation, the patient has experienced no further episodes of gastrointestinal bleeding and has demonstrated satisfactory bowel control. Laparoscopic restorative proctocolectomy with IPAA may be a safe and effective treatment for patients with PJS with synchronous rectal cancer.
基金Supported by Jie-Shou Li Gut Barrier Foundation,No.LJS_201008
文摘AIM To assess the therapeutic potential of Lactobacillus acidophilus(LA) for the treatment of pouchitis in a rat model.METHODS Sprague Dawley rats underwent proctocolectomy and ileal pouch-anal anastomosis followed by administration of dextran sulfate sodium(DSS) to induce pouchitis. Rats with pouchitis were randomly divided into three groups: no intervention(NI), normal saline(NS, 3 m L/d normal saline for 7 d), and LA(3 m L/d LA at 1× 1010 colony-forming units for 7 d). General body condition was recorded and pouch specimens were obtained for histological examination. m RNA expression levels of interleukin(IL)-1β, IL-6, IL-10, and tumor necrosis factor-α were determined by RT-PCR. Zonula occludens protein 1(ZO-1) levels were measured by immunohistochemistry. RESULTS LA reduced weight loss associated with pouchitis(P < 0.05) and improved the symptoms of pouchitis in rats. Compared with the NI and NS groups, rats in the LAgroup showed earlier disappearance of hematochezia(6.17 ± 0.75, 6.50 ± 0.55, 3.17 ± 0.75, P < 0.05) and higher fecal scores(2.67 ± 0.48, 2.50 ± 0.51, 4.42 ± 0.50, respectively, P < 0.05). Histological scores were also lower in the LA group compared with the other two groups(7.17 ± 0.98, 8.00 ± 0.89, 4.00 ± 0.89, respectively, P < 0.05). m RNA expression levels of IL-1β, IL-6, and tumor necrosis factor-α were significantly reduced, while IL-10 m RNA levels were significantly increased in the LA group(P < 0.05, respectively). ZO-1 protein levels were also significantly increased after administration of LA(P < 0.05). CONCLUSION LA alleviates pouchitis induced by DSS after ileal pouchanal anastomosis by decreasing pro-inflammatory factors and increasing anti-inflammatory factors, and restoring ZO-1 expression in the mucosa.
文摘Total proctocolectomy with ileal pouch-anal anastomosis(IPAA) is the current gold standard in the surgical treatment of ulcerative colitis(UC) refractory to medical management. A procedure of significant magnitude carries its own risks including anastomotic failure, pelvic sepsis and a low rate of neoplastic degeneration overtime. Recent studies have shown that total colectomy with ileorectal anastomosis(IRA) has been associated with good long-term functional results in a selected group of UC patients amenable to undergo a strict surveillance for the relatively high risk of cancer in the rectum. This manuscript will review and compare the most recent literature on IRA and IPAA as it pertains to postoperative morbidity and mortality, failure rates, functional outcomes and cancer risk.
文摘Restorative proctocolectomy with ileal pouch-anal anastomosis(RP-IPAA) is the gold standard surgical treatment for ulcerative colitis.However,despite the widespread use of RP-IPAA,many aspects of this treatment still remain controversial,such as the approach(open or laparoscopic),number of stages in the surgery,type of pouch,and construction type(hand-sewn or stapled ileal pouch-anal anastomosis).The present narrative review aims to discuss current evidence on the short-,mid-,and long-term results of each of these technical alternatives as well as their benefits and disadvantages.A review of the MEDLINE,EMBASE,and Ovid databases was performed to identify studies published through March 2016.Few large,randomized,controlled studies have been conducted,which limits the conclusions that can be drawn regarding controversial issues.The available data from retrospective studies suggest that laparoscopic surgery has no clear advantages compared with open surgery and that one-stage RP-IPAA may be indicated in selected cases.Regarding 2- and 3-stage RP-IPAA,patients who underwent these surgeries differed significantly with respect to clinical and laboratory variables,making any comparisons extremely difficult.The long-term results regarding the pouch type show that the W- and J-reservoirs do not differ significantly,although the J pouch is generally preferred by surgeons.Hand-sewn and stapled ileal pouch-anal anastomoses have their own advantages,and there is no clear benefit of one technique over the other.
文摘Primary pouchitis is a common complication of ileal pouch-anal anastomosis following proctocolectomy in patients treated for ulcerative colitis (UC), but is un-usual for those treated for familial adenomatous polyposis (FAP). While a number of theories as to the pathogenesis of this inflammatory condition have been proposed, no single one has been wholly satis-factory. Much research has been devoted to investi-gating a link between the pathogenic factors involved in UC, but not FAP, and those underlying pouchitis. The contribution of sulfate-producing bacteria has also been explored. The role of other intraluminal factors, such as short chain fatty acids and unconju-gated bile salts, has also been investigated. A unifying theory of a multi-step process might explain the pathogenesis of pouchitis, but further research is re-quired to proof causation. It is likely that pouchitis develops as a result of a combination of genetic, im-munological, microbial and metabolic factors. Future insight into the causes of pouchitis may eventually allow for the development of more effective treat-ments.
文摘Background The incidence of chronic ulcerative colitis (CUC) in China is remarkably increasing, while little information on surgical treatment has been reported. This study aimed to completely describe and analyze the clinical outcome of restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA)for CUC in China. Methods Ninety-five consecutive patients, who suffered CUC and had surgical indications, were carefully selected. All patients underwent IPAA. Data on patient characteristics, surgical indications, surgical details, postoperative complications, functional outcome, and quality of life were collected. Results The mean patient age at the time of the operation was 32 years. Twenty-nine (31%) patients underwent an emergency operation, and 66 (69%) underwent elective procedures. Four patients with severe dysplasia underwent operations, but no carcinoma was histologically confirmed. A two-stage operation was performed in 87 (92%) patients, and a hand-sewn technique was applied in 88 (93%) patients. Sixteen patients (17.0%) experienced early complications, and there was a significant difference between the emergency surgery group and the elective group (31.0% vs. 10.6%, respectively; P 〈0.01). Five (5.3%) patients developed pouchitis as a late complication. The mean stool frequency after the operation was 4.6 (2-11) during the first 24 hours and 1.5 (0-4) overnight. According to the Kirwan grading scale, 87 (91.8%) patients showed satisfactory anal continence function. The quality of life improved significantly from a preoperative mean value of 0.28-0.61 before ileostomy closure to 0.78 after ileostomy closure (P 〈0.01) according to the Cleveland Global Quality of Life index. Conclusions IPAA is an effective and safe surgical procedure for patients with CUC in China. However, some characteristics, such as the low incidence of pouchitis, require further study.
文摘Restorative proctocolectomy is the most common surgical option for patients with familial adenomatous polyposis(FAP). However,adenomas may develop in the ileal pouch mucosa over time,and even carcinoma in the pouch has been reported. We therefore reviewed the prevalence,nature,and treatment of adenomas and carcinoma that develop after proctocolectomy in the ileal pouch mucosa in patients with FAP. In 25 reports that were reviewed,the incidence of adenomas in the ileal pouch varied from 6.7% to 73.9%. Several potential factors that favor the development of pouch polyposis have been investigated,but many remain controversial. Nevertheless,it seems certain that the age of the pouch is important. The risk appears to be 7%to 16% after 5 years,35% to 42% after 10 years,and75% after 15 years. On the other hand,only 21 cases of ileal pouch carcinoma have been recorded in the literature to date. The diagnosis of pouch carcinoma was made between 3 to 20 years(median,10 years) after pouch construction. Although the risk of malignant transformation in ileal pouches is probably low,it is not negligible,and the long-term risk cannot presently be well quantified. Regular endoscopic surveillance,especially using chromoendoscopy,is recommended.
文摘AIM:To evaluate if 3 mo oral supplementation with Eviendep was able to reduce the number of duodenal polyps in familial adenomatous polyposis(FAP)patients with ileal pouch-anal anastomosis(IPAA).METHODS:Eleven FAP patients with IPAA and duodenal polyps were enrolled.They underwent upper gastrointestinal(GI)endoscopy at the baseline and after 3 mo of treatment.Each patient received 5 mg Eviendep twice a day,at breakfast and dinner time,for3 mo.Two endoscopists evaluated in a blinded manner the number and size of duodenal polyps.Upper GI endoscopies with biopsies were performed at the baseline(T0)with the assessment of the Spigelman score.Polyps>10 mm were removed during endoscopy and at the end of the procedure a new Spigelman score was determined(T1).The procedure was repeated 3 mo after the baseline(T2).Four photograms were examined for each patient,at T1 and T2.The examined area was divided into 3 segments:duodenal bulb,second and third portion duodenum.Biopsy specimens were taken from all polyps>10 mm and from all suspicious ones,defined by the presence of a central depression,irregular surface,or irregular vascular pattern.Histology was classified according to the updated Vienna criteria.RESULTS:At baseline the mean number of duodenal detected polyps was 27.7 and mean sizes were 15.8mm;the mean Spigelman score was 7.1.After polypectomy the mean number of duodenal detected polyps was 25.7 and mean sizes were 7.6 mm;the mean Spigelman score was 6.4.After 3 mo of Eviendep bid,all patients showed a reduction of number and size of duodenal polyps.The mean number of duodenal polyps was 8(P=0.021)and mean size was 4.4 mm;the mean Spigelman score was 6.6.Interrater agreement was measured.Lesions>1 cm found a very good degree of concordance(kappa 0.851)and a good concordance was as well encountered for smaller lesions(kappa 0.641).CONCLUSION:Our study demonstrated that shortterm(90 d)supplementation with Eviendep in FAP patients with IPAA and with recurrent adenomas in the duodenal mucosa,resulted effective in reducing polyps number of 32%and size of 51%.
文摘The introduction of wireless capsule endoscopy in 2000 has revolutionized our ability to visualize parts of the small bowel mucosa classically unreached by the conventional endoscope, and since the recent introduction of colon capsule endoscopy, a promising alternative method has been available for the evaluation of large bowel mucosa. The advantages of wireless capsule endoscopy include its non-invasive character and its ability to visualize proximal and distal parts of the intestine, while important disadvantages include the procedure's inability of tissue sampling and significant incompletion rate. Its greatest limitation is the prohibited use in cases of known or suspected stenosis of the intestinal lumen due to high risk of retention. Wireless capsule endoscopy plays an important role in the early recognition of recurrence, on Crohn's disease patients who have undergone ileocolonic resection for the treatment of Crohn's disease complications, and in patients' management and therapeutic strategy planning, before obvious clinical and laboratory relapse. Although capsule endoscopy cannot replace traditional endoscopy, it offers valuable information on the evaluation of intestinal disease and has a significant impact on disease reclassification of patients with a previous diagnosis of ulcerative colitis or inflammatory bowel disease unclassified/indeterminate colitis. Moreover, it may serve as an effective alternative where colonoscopy is contraindicated and in cases with incomplete colonoscopy studies. The use of patency capsule maximizes safety and is advocated in cases of suspected small or large bowel stenosis.
文摘Pouchitis is not a rare complication that develops after an ileal-pouch anastomosis, performed after colectomy in patients refractory to treatment or with complicated ulcerative colitis. This condition may become chronic and unresponsive to medical therapies, including corticosteroids, antibiotics and probiotics. The advent of biological therapies(tumor necrosis factor-α inhibitors) has changed the course of these complications. In particular, in these cases, infliximab(IFX) may represent a safe and effective therapy in order to avoid the subsequent operation for a permanent ileostomy. This article reviews the therapeutic effects of one of the most widely used anti-tumor necrosis factor-α molecules, IFX, for the treatment of complicated pouchitis(refractory to conventional treatment and/or fistulizing).