Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?
Autor: | Linda Metaxa, Ioannis Papaconstantinou, Georgios Exarchos, Antonios Gklavas, Vassilis Koutoulidis |
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Rok vydání: | 2018 |
Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Fistula Colonic Pouches Anastomotic Leak Anastomosis Asymptomatic Sensitivity and Specificity Endoscopy Gastrointestinal 030218 nuclear medicine & medical imaging 03 medical and health sciences Ileostomy Young Adult 0302 clinical medicine Postoperative Complications Preoperative Care medicine Humans Radiology Nuclear Medicine and imaging Aged Retrospective Studies medicine.diagnostic_test Proctocolectomy business.industry Proctocolectomy Restorative Interventional radiology General Medicine Middle Aged medicine.disease Ulcerative colitis Surgery 030220 oncology & carcinogenesis Fluoroscopy Colitis Ulcerative Female Radiology medicine.symptom business Pouchoscopy |
Zdroj: | European radiology. 29(4) |
ISSN: | 1432-1084 |
Popis: | 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. 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. 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%. 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. • 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. |
Databáze: | OpenAIRE |
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