PDF(Pubmed)
Abstract：
UNASSIGNED: In patients with inflammatory bowel disease (IBD) for whom medical therapy is unsuccessful or who develop colitis-associated 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.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.
摘要：
■在药物治疗不成功或发展为结肠炎相关瘤形成的炎症性肠病（IBD）患者中，通常需要进行回肠袋-肛门吻合术（IPAA）的恢复性直肠切除术。执行此程序的外科医生的一个考虑因素是是否使用无粘膜切除术的钉合技术或使用具有粘膜切除术的手工缝制技术来创建这种吻合。这项研究测试了IPAA吻合技术与cuffitis和/或囊炎之间的关联，内窥镜评估。
■这是一项回顾性队列研究。我们纳入了连续的IBD成年患者，这些患者在2020年至2022年期间在哥伦比亚大学欧文医学中心接受了IPAA和索引囊镜检查。然后对患者进行随访，从该索引膀胱镜检查≤12个月到随后的膀胱镜检查。主要暴露是粘膜切除术与非粘膜切除术，主要结果是皮肤炎和/或囊炎。定义为袋疾病活动指数内窥镜检查子评分≥1。
■有76例患者符合研究标准，其中49例（64％）接受过粘膜切除术，27例（36％）未接受过粘膜切除术。粘膜切除术者的皮肤炎和/或囊炎发生率为49％，未进行粘膜切除术者为41％（P=0.49）。时间至事件分析证实了这些发现（log-rankP=0.77）。与未进行粘膜切除术的患者相比，进行粘膜切除术的患者更容易形成狭窄（45％vs19％，P=0.02)。
■在IBD患者中，吻合技术与截皮炎和/或囊炎之间没有关联。这些结果可能支持选择吻合术而不是手工缝合吻合术和粘膜切除术。
■这是一项回顾性队列研究。我们纳入了连续的IBD成年患者，这些患者在2020年至2022年期间在哥伦比亚大学欧文医学中心接受了IPAA和索引囊镜检查。然后对患者进行随访，从该索引膀胱镜检查≤12个月到随后的膀胱镜检查。主要暴露是粘膜切除术与非粘膜切除术，主要结果是皮肤炎和/或囊炎。定义为袋疾病活动指数内窥镜检查子评分≥1。
■有76例患者符合研究标准，其中49例（64％）接受过粘膜切除术，27例（36％）未接受过粘膜切除术。粘膜切除术者的皮肤炎和/或囊炎发生率为49％，未进行粘膜切除术者为41％（P=0.49）。时间至事件分析证实了这些发现（log-rankP=0.77）。与未进行粘膜切除术的患者相比，进行粘膜切除术的患者更容易形成狭窄（45％vs19％，P=0.02)。
■在IBD患者中，吻合技术与截皮炎和/或囊炎之间没有关联。这些结果可能支持选择吻合术而不是手工缝合吻合术和粘膜切除术。
