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Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?

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Title: Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?
Authors: Exarchos, Georgios1 exarchos@doctors.org.uk, Metaxa, Linda2, Gklavas, Antonios1, Koutoulidis, Vassilis3, Papaconstantinou, Ioannis1
Source: European Radiology. Apr2019, Vol. 29 Issue 4, p1754-1761. 8p. 1 Color Photograph, 2 Black and White Photographs, 1 Chart.
Subjects: Restorative proctocolectomy, Ulcerative colitis, Comparative studies, Fluoroscopy, Ileostomy, Research methodology, Medical cooperation, Preoperative care, Research, Surgical complications, Evaluation research, Retrospective studies, Endoscopic gastrointestinal surgery
Abstract: Objectives: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the "gold standard" procedure for patients with ulcerative colitis (UC) requiring surgical intervention. A de-functioning ileostomy is usually performed, as a step for the IPAA procedure. The aim of this study is to present the methodology and results of the routine double assessment of IPAA integrity in asymptomatic patients prior to the ileostomy reversal and evaluate its necessity.Methods: This is a retrospective study of 61 UC patients, who underwent IPAA construction, in 2010-2016. A diverting ileostomy was created after IPAA construction, which was reversed at least 3 months later. A double assessment, with pouchogram and pouchoscopy, of IPAA integrity was performed, before stoma closure. Post-operative symptoms and signs of complications, imaging studies, and endoscopic findings were recorded during follow-up.Results: Prior to the ileostomy reversal, both pouchoscopy and pouchogram identified no patient with evidence of anastomotic leakage. During a mean follow-up of 3.67 years after ileostomy reversal, 11 patients developed complications but only one had signs of leakage, which presented as a pouch-vaginal fistula. The specificity of both the pouchogram and pouchoscopy reached 100% and the negative predictive value ranged between 98.4 and 100%.Conclusions: The specificity of pouchoscopy and pouchogram prior to ileostomy closure, in asymptomatic patients with IPAA for UC, is very high in recognizing an intact anastomosis, but their combination did not alter the diagnostic accuracy or had any effect in further management. At least, pouchogram could be selectively performed only in patients with high-risk clinical indicators.Key Points: • The double assessment of ileal pouch-anal anastomosis with pouchogram and pouchoscopy, prior to ileostomy closure, specifically in patients with ulcerative colitis has not been evaluated before. • The specificity of pouchoscopy and pouchogram prior to ileostomy closure, in asymptomatic patients with IPAA for UC, is very high in recognizing an intact anastomosis. • However, their combination did not alter the diagnostic accuracy or had any effect in further management, in asymptomatic patients. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?
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  Data: <searchLink fieldCode="AR" term="%22Exarchos%2C+Georgios%22">Exarchos, Georgios</searchLink><relatesTo>1</relatesTo><i> exarchos@doctors.org.uk</i><br /><searchLink fieldCode="AR" term="%22Metaxa%2C+Linda%22">Metaxa, Linda</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Gklavas%2C+Antonios%22">Gklavas, Antonios</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Koutoulidis%2C+Vassilis%22">Koutoulidis, Vassilis</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Papaconstantinou%2C+Ioannis%22">Papaconstantinou, Ioannis</searchLink><relatesTo>1</relatesTo>
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  Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. Apr2019, Vol. 29 Issue 4, p1754-1761. 8p. 1 Color Photograph, 2 Black and White Photographs, 1 Chart.
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  Data: <searchLink fieldCode="DE" term="%22Restorative+proctocolectomy%22">Restorative proctocolectomy</searchLink><br /><searchLink fieldCode="DE" term="%22Ulcerative+colitis%22">Ulcerative colitis</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+studies%22">Comparative studies</searchLink><br /><searchLink fieldCode="DE" term="%22Fluoroscopy%22">Fluoroscopy</searchLink><br /><searchLink fieldCode="DE" term="%22Ileostomy%22">Ileostomy</searchLink><br /><searchLink fieldCode="DE" term="%22Research+methodology%22">Research methodology</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+cooperation%22">Medical cooperation</searchLink><br /><searchLink fieldCode="DE" term="%22Preoperative+care%22">Preoperative care</searchLink><br /><searchLink fieldCode="DE" term="%22Research%22">Research</searchLink><br /><searchLink fieldCode="DE" term="%22Surgical+complications%22">Surgical complications</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation+research%22">Evaluation research</searchLink><br /><searchLink fieldCode="DE" term="%22Retrospective+studies%22">Retrospective studies</searchLink><br /><searchLink fieldCode="DE" term="%22Endoscopic+gastrointestinal+surgery%22">Endoscopic gastrointestinal surgery</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: <bold>Objectives: </bold>Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the "gold standard" procedure for patients with ulcerative colitis (UC) requiring surgical intervention. A de-functioning ileostomy is usually performed, as a step for the IPAA procedure. The aim of this study is to present the methodology and results of the routine double assessment of IPAA integrity in asymptomatic patients prior to the ileostomy reversal and evaluate its necessity.<bold>Methods: </bold>This is a retrospective study of 61 UC patients, who underwent IPAA construction, in 2010-2016. A diverting ileostomy was created after IPAA construction, which was reversed at least 3 months later. A double assessment, with pouchogram and pouchoscopy, of IPAA integrity was performed, before stoma closure. Post-operative symptoms and signs of complications, imaging studies, and endoscopic findings were recorded during follow-up.<bold>Results: </bold>Prior to the ileostomy reversal, both pouchoscopy and pouchogram identified no patient with evidence of anastomotic leakage. During a mean follow-up of 3.67 years after ileostomy reversal, 11 patients developed complications but only one had signs of leakage, which presented as a pouch-vaginal fistula. The specificity of both the pouchogram and pouchoscopy reached 100% and the negative predictive value ranged between 98.4 and 100%.<bold>Conclusions: </bold>The specificity of pouchoscopy and pouchogram prior to ileostomy closure, in asymptomatic patients with IPAA for UC, is very high in recognizing an intact anastomosis, but their combination did not alter the diagnostic accuracy or had any effect in further management. At least, pouchogram could be selectively performed only in patients with high-risk clinical indicators.<bold>Key Points: </bold>• The double assessment of ileal pouch-anal anastomosis with pouchogram and pouchoscopy, prior to ileostomy closure, specifically in patients with ulcerative colitis has not been evaluated before. • The specificity of pouchoscopy and pouchogram prior to ileostomy closure, in asymptomatic patients with IPAA for UC, is very high in recognizing an intact anastomosis. • However, their combination did not alter the diagnostic accuracy or had any effect in further management, in asymptomatic patients. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1007/s00330-018-5760-0
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        Text: English
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        PageCount: 8
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      – SubjectFull: Restorative proctocolectomy
        Type: general
      – SubjectFull: Ulcerative colitis
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      – SubjectFull: Ileostomy
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      – TitleFull: Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?
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