Introduction Cuffitis is a common phenotype of inflammatory disorder located at the rectal cuff of ileal pouch-anal anastomosis(IPAA)in those with underlying ulcerative colitis(UC)[1,2].Classic cuffitis is considered ...Introduction Cuffitis is a common phenotype of inflammatory disorder located at the rectal cuff of ileal pouch-anal anastomosis(IPAA)in those with underlying ulcerative colitis(UC)[1,2].Classic cuffitis is considered a form of remnant UC following IPAA without mucosectomy.Patients with cuffitis usually respond to topical mesalamine or topical corticosteroid therapy[3,4].Cuffitis can result from other etiologies,such as Crohn’s disease(CD)and prolapse,which often present with asymmetric distribution of the cuff inflammation[1,5].Common symptoms of cuffitis are urgency,frequency,bleeding,and pelvic pressure.Despite advances in the diagnosis and management of ileal pouch disorders,some patients with cuffitis poorly respond to topical and systemic medical therapy.In this brief report,we describe a case in which cuffitis was resolved by the removal of dislodged surgical staples from the anastomosis,suggesting a contributing role of the staples in cuffitis.展开更多
Background:In patients with inflammatory bowel disease(IBD)for whom medical therapy is unsuccessful or who develop colitis-as-sociated neoplasia,restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA)is of...Background:In patients with inflammatory bowel disease(IBD)for whom medical therapy is unsuccessful or who develop colitis-as-sociated neoplasia,restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA)is often indicated.One consideration for surgeons performing this procedure is whether to create this anastomosis using a stapled technique without mucosectomy or using a hand-sewn technique with mucosectomy.This study tested the association between IPAA anastomosis technique and cuffitis and/or pouchitis,assessed endoscopically.Methods:This was a retrospective cohort study.We included consecutive adult patients with IBD who had undergone IPAA and had received index pouchoscopies at Columbia University Irving Medical Center between 2020 and 2022.Patients were then followed up from this index pouchoscopy for≤12 months to a subsequent pouchoscopy.The primary exposure was mucosectomy vs non-mucosectomy and the primary outcome was cuffitis and/or pouchitis,defined as a Pouch Disease Activity Index endoscopy subscore of≥1.Results:There were 76 patients who met study criteria including 49(64%)who had undergone mucosectomy and 27(36%)who had not.Rates of cuffitis and/or pouchitis were 49%among those with mucosectomy vs 41%among those without mucosectomy(P=0.49).Time-to-event analysis affirmed these findings(log-rank P=0.77).Stricture formation was more likely among patients with mucosectomy compared with those without mucosectomy(45%vs 19%,P=0.02).Conclusions:There was no association between anastomosis technique and cuffitis and/or pouchitis among patients with IBD.These results may support the selection of stapled anastomosis over hand-sewn anastomosis with mucosectomy.展开更多
文摘Introduction Cuffitis is a common phenotype of inflammatory disorder located at the rectal cuff of ileal pouch-anal anastomosis(IPAA)in those with underlying ulcerative colitis(UC)[1,2].Classic cuffitis is considered a form of remnant UC following IPAA without mucosectomy.Patients with cuffitis usually respond to topical mesalamine or topical corticosteroid therapy[3,4].Cuffitis can result from other etiologies,such as Crohn’s disease(CD)and prolapse,which often present with asymmetric distribution of the cuff inflammation[1,5].Common symptoms of cuffitis are urgency,frequency,bleeding,and pelvic pressure.Despite advances in the diagnosis and management of ileal pouch disorders,some patients with cuffitis poorly respond to topical and systemic medical therapy.In this brief report,we describe a case in which cuffitis was resolved by the removal of dislodged surgical staples from the anastomosis,suggesting a contributing role of the staples in cuffitis.
文摘Background:In patients with inflammatory bowel disease(IBD)for whom medical therapy is unsuccessful or who develop colitis-as-sociated neoplasia,restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA)is often indicated.One consideration for surgeons performing this procedure is whether to create this anastomosis using a stapled technique without mucosectomy or using a hand-sewn technique with mucosectomy.This study tested the association between IPAA anastomosis technique and cuffitis and/or pouchitis,assessed endoscopically.Methods:This was a retrospective cohort study.We included consecutive adult patients with IBD who had undergone IPAA and had received index pouchoscopies at Columbia University Irving Medical Center between 2020 and 2022.Patients were then followed up from this index pouchoscopy for≤12 months to a subsequent pouchoscopy.The primary exposure was mucosectomy vs non-mucosectomy and the primary outcome was cuffitis and/or pouchitis,defined as a Pouch Disease Activity Index endoscopy subscore of≥1.Results:There were 76 patients who met study criteria including 49(64%)who had undergone mucosectomy and 27(36%)who had not.Rates of cuffitis and/or pouchitis were 49%among those with mucosectomy vs 41%among those without mucosectomy(P=0.49).Time-to-event analysis affirmed these findings(log-rank P=0.77).Stricture formation was more likely among patients with mucosectomy compared with those without mucosectomy(45%vs 19%,P=0.02).Conclusions:There was no association between anastomosis technique and cuffitis and/or pouchitis among patients with IBD.These results may support the selection of stapled anastomosis over hand-sewn anastomosis with mucosectomy.
