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Inflammation and Neoplasia of the Pouch in Inflammatory Bowel Disease

  • Large Intestine (B Cash and R Chokshi, Section Editors)
  • Published:
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Abstract

Purpose of Review

Ileal pouch-anal anastomosis (IPAA) is the standard restorative procedure after proctocolectomy in patients with inflammatory bowel disease who require colectomy. The ileal pouch is susceptible to a variety of adverse outcomes including mechanical insult, ischemia, and infectious agents. There is also a risk for developing low-grade dysplasia (LGD), high-grade dysplasia (HGD), or even adenocarcinoma in the pouch. The purpose of this review is to highlight risk factors, clinical presentation, surveillance, and treatment of pouch neoplasia.

Recent Findings

Patients with pre-colectomy colitis-associated neoplasia are at high risk for developing pouch neoplasia. Other purported risk factors include the presence of family history of colorectal cancer, the presence of concurrent primary sclerosing cholangitis, chronic pouchitis, cuffitis, or Crohn’s disease of the pouch. Pouch adenocarcinoma tends to have a poor prognosis.

Summary

It is recommended to have a combined clinical, endoscopic, and histologic approach in diagnosis and management. Surveillance and management algorithms of pouch neoplasia are proposed, based on the risk stratification.

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Abbreviations

ATZ:

Anal transitional zone

CAN:

Colitis-associated neoplasia

CD:

Crohn’s disease

CRC:

Colorectal cancer

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

FAP:

Familial adenomatous polyposis

HGD:

High-grade dysplasia

IBD:

Inflammatory bowel disease

IND:

Indefinite for dysplasia

IPAA:

Ileal pouch-anal anastomosis

LGD:

Low-grade dysplasia

PSC:

Primary sclerosing cholangitis

UC:

Ulcerative colitis

References

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Authors and Affiliations

  1. Department of Gastroenterology/Hepatology/Nutrition, Cleveland Clinic, Cleveland, OH, USA

    Freeha Khan & Bo Shen

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  1. Freeha Khan
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  2. Bo Shen
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Correspondence to Bo Shen.

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Khan, F., Shen, B. Inflammation and Neoplasia of the Pouch in Inflammatory Bowel Disease. Curr Gastroenterol Rep 21, 10 (2019). https://doi.org/10.1007/s11894-019-0679-4

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