Mistakes in pouchitis and how to avoid them

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Mistakes in pouchitis and how to avoid them

Ailsa L Hart, Susan K. Clark, Jonathan P Segal

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Lepistö A, Luukkonen P and Järvinen HJ. Cumulative failure rate of ileal pouch-anal anastomosis and quality of life after failure. Dis Colon Rectum 2002; 45: 1289–1294. [Link]

Sandborn WJ. Pouchitis: definition, risk factors, frequency, natural history, classification, and public health perspective. In: Sutherland LR, Mcleod RS, Noel Williams C, Martin F and Wallace JL (eds) Trends in Inflammatory Bowel Disease Therapy 1996. 1997; Springer Netherlands, 1997, p.51–63.

Pardi DS and Shen B. Endoscopy in the management of patients after ileal pouch surgery for ulcerative colitis. Endoscopy 2008; 40: 529–533. [Link]

Shen B. Pouchitis: What every gastroenterologist needs to know. Clin Gastroenterol Hepatol 2013; 11: 1538–1549. [Link]

Sandborn WJ, Tremaine WJ, Batts KP, et al. Pouchitis after ileal pouch-anal anastomosis: a pouchitis disease activity index. Mayo Clin Proc 1994; 69: 409–415. [Link]

Ben-Bassat O, Tyler AD, Xu W, et al. Ileal pouch symptoms do not correlate with inflammation of the pouch. Clin Gastroenterol Hepatol 2014; 12: 831–837.e2. [Link]

van der Ploeg V, Maeda Y, Faiz OD, et al. The prevalence of chronic peri-pouch sepsis in patients treated for antibiotic-dependent or refractory primary idiopathic pouchitis. Colorectal Dis 2017; 19: 827–831. [Link]

Navaneethan U and Shen B. Secondary pouchitis: Those with identifiable etiopathogenetic or triggering factors. Am J Gastroenterol 2010; 105: 51–64. [Link]

Segal JP, Ding NS, Worley G, et al. Systematic review with meta-analysis: the management of chronic refractory pouchitis with an evidence-based treatment algorithm. Aliment Pharmacol Ther 2017; 45: 581–592. [Link]

10.

Annerijn van der Ploeg V, Maeda Y, Faiz OD, et al. Standardising assessment and documentation of pouchoscopy. Frontline Gastroenterol 2018; 9: 309–314. [Link]

11.

Samaan MA, Shen B, Mosli MH, et al. Reliability among central readers in the evaluation of endoscopic disease activity in pouchitis. Gastrointest Endosc 2018; 88: 360–369.e2. [Link]

12.

Segal JP, Chan H, Collins B, et al. Biofeedback in patients with ileoanal pouch dysfunction: a specialist centre experience. Scand J Gastroenterol 2018; 53: 665–669. [Link]

13.

Shen B. Diagnosis and management of postoperative ileal pouch disorders. Clin Colon Rectal Surg 2010; 23: 259–268. [Link]

14.

Shen B, Lashner BA, Bennett AE, et al. Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis. Am J Gastroenterol 2004; 99: 1527–1531. [Link]

15.

Thompson-Fawcett MW, Mortensen NJ, Warren BF. Cuffitis and inflammatory changes in the columnar cuff, anal transitional zone, and ileal reservoir after stapled pouch-anal anastomosis. Dis Colon Rectum 1999; 42: 348–355. [Link]

16.

Thompson JS. Cuffitis: A new cause of pouch dysfunction. Am J Gastroenterol 1999; 94: 2007. [Link]

17.

Wu B, Lian L, Li Y, et al. Clinical course of cuffitis in ulcerative colitis patients with restorative proctocolectomy and ileal pouch–anal anastomoses. Inflamm Bowel Dis 2013; 19: 404–410. [Link]

18.

Phillips RK. Ileal pouch-anal anastomosis for Crohn’s disease. Gut 1998; 43: 303–304. [Link]

19.

Hartley JE, Fazio VW, Remzi FH, et al. Analysis of the outcome of ileal pouch-anal anastomosis in patients with Crohn’s disease. Dis Colon Rectum 2004; 47: 1808–1815. [Link]

20.

Brown CJ, Maclean AR, Cohen Z, et al. Crohn’s disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure. Dis Colon Rectum 2005; 48: 1542–1549. [Link]

21.

Yu CS, Pemberton JH and Larson D. Ileal pouch-anal anastomosis in patients with indeterminate colitis: long-term results. Dis Colon Rectum 2000; 43: 1487–1496. [Link]

22.

Keighley MR. The final diagnosis in pouch patients for presumed ulcerative colitis may change to Crohn’s disease: patients should be warned of the consequences. Acta Chir Iugosl 2000; 47: 27–31. [Link]

23.

Gu J, Stocchi L, Kiran RP, et al. Do clinical characteristics of de novo pouch crohns disease after restorative proctocolectomy affect ileal pouch retention? Dis Colon Rectum 2014; 57: 76–82. [Link]

24.

Panis Y, Poupard B, Nemeth J, et al. Ileal pouch/anal anastomosis for Crohn’s disease. Lancet 1996; 347: 854–857. [Link]

25.

Regimbeau JM, Panis Y, Pocard M, et al. Long-term results of ileal pouch-anal anastomosis for colorectal Crohn’s disease. Dis Colon Rectum 2001; 44: 769–778. [Link]

26.

Bemelman WA, Warusavitarne J, Sampietro GM, et al. ECCO-ESCP consensus on surgery for crohn’s disease. J Crohn’s Colitis 2017; 12: 1–16. [Link]

27.

Deutsch AA, McLeod RS, Cullen J, et al. Results of the pelvic-pouch procedure in patients with Crohn’s disease. Dis Colon Rectum 1991;34:475–477. [Link]

28.

Grobler SP, Hosie KB and Keighley MRB. Randomized trial of loop ileostomy in restorative proctocolectomy. Br J Surg 1992; 79: 903–906. [Link]

29.

Hyman NH, Fazio VW, Tuckson WB, et al. Consequences of ileal pouch-anal anastomosis for Crohn’s colitis. Dis Colon Rectum 1991; 34: 653–657. [Link]

30.

Shen B, Fazio VW, Remzi FH, et al. Clinical features and quality of life in patients with different phenotypes of crohnʼs disease of the ileal pouch. Dis Colon Rectum 2007; 50: 1450–1459. [Link]

31.

Shen B, Fazio VW, Remzi FH, et al. Risk factors for clinical phenotypes of crohn’s disease of the ileal pouch. Am J Gastroenterol 2006; 101: 2760–2768. [Link]

32.

Wolf JM, Achkar J-P, Lashner BA, et al. Afferent limb ulcers predict Crohn’s disease in patients with ileal pouch-anal anastomosis. Gastroenterology 2004; 126: 1686–1691. [Link]

33.

Lightner AL, Fletcher JG, Pemberton JH, et al. Crohn’s disease of the pouch: A true diagnosis or an oversubscribed diagnosis of exclusion? Dis Colon Rectum 2017; 60: 1201–1208. [Link]

34.

Segal JP, Poo SX, McLaughlin SD, et al. Long-term follow-up of the use of maintenance antibiotic therapy for chronic antibiotic-dependent pouchitis. Frontline Gastroenterol 2018; 9: 154–158. [Link]

35.

Kim GK. The risk of fluoroquinolone-induced tendinopathy and tendon rupture: what does the clinician need to know? J Clin Aesthet Dermatol 2010; 3: 49–54. [Link]

36.

Goolsby TA, Jakeman B and Gaynes RP. Clinical relevance of metronidazole and peripheral neuropathy: a systematic review of the literature. Int J Antimicrob Agents 2018; 51: 319–325. [Link]

37.

Seril DN and Shen B. Clostridium difficile infection in patients with ileal pouches. Am J Gastroenterol 2014; 109: 941–947. [Link]

38.

Herfarth HH, Long MD and Isaacs KL. Use of biologics in pouchitis. J Clin Gastroenterol 2015; 49: 647–654. [Link]

39.

Weaver KN, Gregory M, Syal G, et al. Ustekinumab is effective for the treatment of crohn’s disease of the pouch in a multicenter cohort. Inflamm Bowel Dis 2019;25:767–774. [Link]

40.

Gregory M, Weaver KN, Hoversten P, et al. Efficacy of vedolizumab for refractory pouchitis of the ileo-anal pouch: results from a multicenter US cohort. Inflamm Bowel Dis 2019; 25: 1569–1576. [Link]

41.

‘Study to compare alicaforsen with placebo in patients with pouchitis’ NHS Health Research Authority https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/study-to-compare-alicaforsen-with-placebo-in-patients-with-pouchitis/ (accessed April 2020). [Link]

42.

Godny L, Maharshak N, Reshef L, et al. Fruit consumption is associated with alterations in microbial composition and lower rates of pouchitis. J Crohn’s Colitis 2019; 13: 1265–1272. [Link]

43.

Ianco O, Tulchinsky H, Lusthaus M, et al. Diet of patients after pouch surgery may affect pouch inflammation. World J Gastroenterol 2013; 19: 6458. [Link]

44.

Kuisma J, Nuutinen H, Luukkonen P, et al. Long term metabolic consequences of ileal pouch-anal anastomosis for ulcerative colitis. Am J Gastroenterol 2001; 96: 3110–3116. [Link]

45.

Pastrana RJ, Torres EA, Arroyo JM, et al. Iron-deficiency anemia as presentation of pouchitis. J Clin Gastroenterol 2007; 41: 41–44. doi:10.1097/01.mcg.0000212641.90477.d0 [Link]

46.

Helavirta I, Huhtala H, Hyöty M, et al. Restorative proctocolectomy for ulcerative colitis in 1985–2009. Scand J Surg 2016; 105: 73–77. [Link]

Abstract

Topics

Small Intestine & Nutrition

Citation

Jonathan P Segal JP, Clark SK and Hart AL. Mistakes in pouchitis and how to avoid them. UEG Education 2020; 20: 7–11.

Published

2020

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Mistakes in endoscopic treatment of Barrett oesophagus neoplasia and how to avoid them

Jacques J. Bergman, Roos E. Pouw, Eva Verheij

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Lepistö A, Luukkonen P and Järvinen HJ. Cumulative failure rate of ileal pouch-anal anastomosis and quality of life after failure. Dis Colon Rectum 2002; 45: 1289–1294. [Link]

Pardi DS and Shen B. Endoscopy in the management of patients after ileal pouch surgery for ulcerative colitis. Endoscopy 2008; 40: 529–533. [Link]

Shen B. Pouchitis: What every gastroenterologist needs to know. Clin Gastroenterol Hepatol 2013; 11: 1538–1549. [Link]

Sandborn WJ, Tremaine WJ, Batts KP, et al. Pouchitis after ileal pouch-anal anastomosis: a pouchitis disease activity index. Mayo Clin Proc 1994; 69: 409–415. [Link]

Ben-Bassat O, Tyler AD, Xu W, et al. Ileal pouch symptoms do not correlate with inflammation of the pouch. Clin Gastroenterol Hepatol 2014; 12: 831–837.e2. [Link]

Navaneethan U and Shen B. Secondary pouchitis: Those with identifiable etiopathogenetic or triggering factors. Am J Gastroenterol 2010; 105: 51–64. [Link]

10.

Annerijn van der Ploeg V, Maeda Y, Faiz OD, et al. Standardising assessment and documentation of pouchoscopy. Frontline Gastroenterol 2018; 9: 309–314. [Link]

11.

Samaan MA, Shen B, Mosli MH, et al. Reliability among central readers in the evaluation of endoscopic disease activity in pouchitis. Gastrointest Endosc 2018; 88: 360–369.e2. [Link]

12.

Segal JP, Chan H, Collins B, et al. Biofeedback in patients with ileoanal pouch dysfunction: a specialist centre experience. Scand J Gastroenterol 2018; 53: 665–669. [Link]

13.

Shen B. Diagnosis and management of postoperative ileal pouch disorders. Clin Colon Rectal Surg 2010; 23: 259–268. [Link]

14.

15.

16.

Thompson JS. Cuffitis: A new cause of pouch dysfunction. Am J Gastroenterol 1999; 94: 2007. [Link]

17.

18.

Phillips RK. Ileal pouch-anal anastomosis for Crohn’s disease. Gut 1998; 43: 303–304. [Link]

19.

Hartley JE, Fazio VW, Remzi FH, et al. Analysis of the outcome of ileal pouch-anal anastomosis in patients with Crohn’s disease. Dis Colon Rectum 2004; 47: 1808–1815. [Link]

20.

21.

Yu CS, Pemberton JH and Larson D. Ileal pouch-anal anastomosis in patients with indeterminate colitis: long-term results. Dis Colon Rectum 2000; 43: 1487–1496. [Link]

22.

23.

24.

Panis Y, Poupard B, Nemeth J, et al. Ileal pouch/anal anastomosis for Crohn’s disease. Lancet 1996; 347: 854–857. [Link]

25.

Regimbeau JM, Panis Y, Pocard M, et al. Long-term results of ileal pouch-anal anastomosis for colorectal Crohn’s disease. Dis Colon Rectum 2001; 44: 769–778. [Link]

26.

Bemelman WA, Warusavitarne J, Sampietro GM, et al. ECCO-ESCP consensus on surgery for crohn’s disease. J Crohn’s Colitis 2017; 12: 1–16. [Link]

27.

Deutsch AA, McLeod RS, Cullen J, et al. Results of the pelvic-pouch procedure in patients with Crohn’s disease. Dis Colon Rectum 1991;34:475–477. [Link]

28.

Grobler SP, Hosie KB and Keighley MRB. Randomized trial of loop ileostomy in restorative proctocolectomy. Br J Surg 1992; 79: 903–906. [Link]

29.

Hyman NH, Fazio VW, Tuckson WB, et al. Consequences of ileal pouch-anal anastomosis for Crohn’s colitis. Dis Colon Rectum 1991; 34: 653–657. [Link]

30.

Shen B, Fazio VW, Remzi FH, et al. Clinical features and quality of life in patients with different phenotypes of crohnʼs disease of the ileal pouch. Dis Colon Rectum 2007; 50: 1450–1459. [Link]

31.

Shen B, Fazio VW, Remzi FH, et al. Risk factors for clinical phenotypes of crohn’s disease of the ileal pouch. Am J Gastroenterol 2006; 101: 2760–2768. [Link]

32.

Wolf JM, Achkar J-P, Lashner BA, et al. Afferent limb ulcers predict Crohn’s disease in patients with ileal pouch-anal anastomosis. Gastroenterology 2004; 126: 1686–1691. [Link]

33.

Lightner AL, Fletcher JG, Pemberton JH, et al. Crohn’s disease of the pouch: A true diagnosis or an oversubscribed diagnosis of exclusion? Dis Colon Rectum 2017; 60: 1201–1208. [Link]

34.

Segal JP, Poo SX, McLaughlin SD, et al. Long-term follow-up of the use of maintenance antibiotic therapy for chronic antibiotic-dependent pouchitis. Frontline Gastroenterol 2018; 9: 154–158. [Link]

35.

Kim GK. The risk of fluoroquinolone-induced tendinopathy and tendon rupture: what does the clinician need to know? J Clin Aesthet Dermatol 2010; 3: 49–54. [Link]

36.

Goolsby TA, Jakeman B and Gaynes RP. Clinical relevance of metronidazole and peripheral neuropathy: a systematic review of the literature. Int J Antimicrob Agents 2018; 51: 319–325. [Link]

37.

Seril DN and Shen B. Clostridium difficile infection in patients with ileal pouches. Am J Gastroenterol 2014; 109: 941–947. [Link]

38.

Herfarth HH, Long MD and Isaacs KL. Use of biologics in pouchitis. J Clin Gastroenterol 2015; 49: 647–654. [Link]

39.

Weaver KN, Gregory M, Syal G, et al. Ustekinumab is effective for the treatment of crohn’s disease of the pouch in a multicenter cohort. Inflamm Bowel Dis 2019;25:767–774. [Link]

40.

41.

42.

Godny L, Maharshak N, Reshef L, et al. Fruit consumption is associated with alterations in microbial composition and lower rates of pouchitis. J Crohn’s Colitis 2019; 13: 1265–1272. [Link]

43.

Ianco O, Tulchinsky H, Lusthaus M, et al. Diet of patients after pouch surgery may affect pouch inflammation. World J Gastroenterol 2013; 19: 6458. [Link]

44.

Kuisma J, Nuutinen H, Luukkonen P, et al. Long term metabolic consequences of ileal pouch-anal anastomosis for ulcerative colitis. Am J Gastroenterol 2001; 96: 3110–3116. [Link]

45.

Pastrana RJ, Torres EA, Arroyo JM, et al. Iron-deficiency anemia as presentation of pouchitis. J Clin Gastroenterol 2007; 41: 41–44. doi:10.1097/01.mcg.0000212641.90477.d0 [Link]

46.

Helavirta I, Huhtala H, Hyöty M, et al. Restorative proctocolectomy for ulcerative colitis in 1985–2009. Scand J Surg 2016; 105: 73–77. [Link]

Abstract

Barrett’s oesophagus is a premalignant condition of the distal oesophagus predisposing to oesophageal adenocarcinoma. Given the potential for malignant progression and the poor prognosis of eosophageal adenocarcinoma when diagnosed at a symptomatic stage, patients with known Barrett oesophagus undergo regular endoscopic surveillance to detect neoplastic progression at an early and preferably endoscopically, treatable stage. Endoscopic management of early Barrett oesophagus neoplasia consists of a combination of endoscopic imaging, endoscopic resection and endoscopic ablation. Below we discuss a number of mistakes that are frequently made when managing Barrett oesophagus neoplasia and how to avoid them. Much of this discussion draws on existing guidelines (for background reading, check the ESGE Barrett oesophagus guideline), but in many instances the underlying evidence (even in the guideline) is missing and therefore many of our practically driven recommendations are based on common sense and our experience in this field.

Topics

Oesophagus

Citation

Verheij EPD, Pouw RE and Bergman JJ. Mistakes in endoscopic treatment of Barrett oesophagus neoplasia and how to avoid them. UEG Education 2021; 21: 35–39.

Published

2021

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Summary

AI Generated

Summary is not available for this content yet.

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Was this helpful?

Thanks for your feedback.

Abstract

Topics

Digestive Oncology Endoscopy Oesophagus

Published

2025

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UEG Standards and Guidelines

Clinical Practice Guideline

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Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020

Jeanin van Hooft

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AI Generated

Summary is not available for this content yet.

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Guideline

Main recommendations

The following recommendations should only be applied after a thorough diagnostic evaluation including a contrast- enhanced computed tomography (CT) scan.

1 ESGE recommends colonic stenting to be reserved for patients with clinical symptoms and radiological signs of malignant large-bowel obstruction, without signs of perforation. ESGE does not recommend prophylactic stent placement.
Strong recommendation, low quality evidence.

2 ESGE recommends stenting as a bridge to surgery to be discussed, within a shared decision-making process, as a treatment option in patients with potentially curable left-sided obstructing colon cancer as an alternative to emergency resection.
Strong recommendation, high quality evidence.

3 ESGE recommends colonic stenting as the preferred treatment for palliation of malignant colonic obstruction.
Strong recommendation, high quality evidence.

4 ESGE suggests consideration of colonic stenting for malignant obstruction of the proximal colon either as a bridge to surgery or in a palliative setting.
Weak recommendation, low quality evidence.

5 ESGE suggests a time interval of approximately 2 weeks until resection when colonic stenting is performed as a bridge to elective surgery in patients with curable left-sided colon cancer.
Weak recommendation, low quality evidence.

6 ESGE recommends that colonic stenting should be performed or directly supervised by an operator who can demonstrate competence in both colonoscopy and fluoroscopic techniques and who performs colonic stenting on a regular basis.
Strong recommendation, low quality evidence.

7 ESGE suggests that a decompressing stoma as a bridge to elective surgery is a valid option if the patient is not a candidate for colonic stenting or when stenting expertise is not available.
Weak recommendation, low quality evidence.

Publisher

European Society of Gastrointestinal Endoscopy

Guideline

Clinical Practice Guideline

Topics

Digestive Oncology Endoscopy

Citation

Endoscopy. 2020 May;52(5):389-407

Published

2020

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