背景:炎症性肠病(IBD)患者行直肠结肠切除术并进行回肠袋-肛门吻合术可能会发生囊炎。我们先前提出了一种新的内窥镜下囊炎分类,描述了7种具有不同结果的表型。该研究评估了随时间的表型转变。
方法:我们将小袋发现分为7种主要表型:(1)正常,(2)传入肢体(AL)受累,(3)进口(IL)参与,(4)弥漫性,(5)囊体的局灶性炎症,(6)cuffitis,和(7)回肠造口术后超过6个月发现的与囊相关的瘘。在2种内窥镜表型中,首次鉴定的表型被定义为主要表型,随后观察到的表型被定义为随后的表型。
结果:我们回顾性回顾了426例患者的1359次膀胱镜检查(90%术前诊断为溃疡性结肠炎)。主要表型的频率为31%的AL参与,42%为IL参与,28%为弥漫性炎症,72%为局灶性炎症,45%为Cuffitis,18%用于与囊袋相关的瘘管,和28%的正常袋。最常见的后续表型是局灶性炎症(64.8%),其次是IL参与(38.6%),库菲蒂斯(37.8%),AL参与(25.6%),弥漫性炎症(23.8%),正常眼袋(22.8%),及与储袋有关的瘘管(11.9%)。随后弥漫性炎症,与小袋有关的瘘管,AL或IL狭窄显着增加了囊切除的风险。与未进行囊袋切除的患者相比,随后达到正常囊袋的患者不太可能进行囊袋切除(8.1%vs15.7%;P=.15)。
结论:小袋表型和小袋丢失的风险可随时间变化。在患有囊袋炎症的患者中,随后的囊袋正常化是可行的,并且与有利的结果相关。
内镜下小袋表型可以随着时间的推移而改变,并随后发展为弥漫性炎症,与小袋有关的瘘管,和传入肢体/入口狭窄显着恶化囊的结果。在患有囊袋炎症的患者中,随后的囊袋正常化是可行的,并且与有利的结果相关。
BACKGROUND: Patients with inflammatory bowel disease (IBD) who undergo proctocolectomy with ileal pouch-anal anastomosis may develop
pouchitis. We previously proposed a novel endoscopic classification of
pouchitis describing 7 phenotypes with differing outcomes. This study assessed phenotype transitions over time.
METHODS: We classified pouch findings into 7 main phenotypes: (1) normal, (2) afferent limb (AL) involvement, (3) inlet (IL) involvement, (4) diffuse, (5) focal inflammation of the pouch body, (6) cuffitis, and (7) pouch-related fistulas noted more than 6 months after ileostomy takedown. Among 2 endoscopic phenotypes, the phenotype that was first identified was defined as the primary phenotype, and the phenotype observed later was defined as the subsequent phenotype.
RESULTS: We retrospectively reviewed 1359 pouchoscopies from 426 patients (90% preoperative diagnosis of ulcerative colitis). The frequency of primary phenotype was 31% for AL involvement, 42% for IL involvement, 28% for diffuse inflammation, 72% for focal inflammation, 45% for cuffitis, 18% for pouch-related fistulas, and 28% for normal pouch. The most common subsequent phenotype was focal inflammation (64.8%), followed by IL involvement (38.6%), cuffitis (37.8%), AL involvement (25.6%), diffuse inflammation (23.8%), normal pouch (22.8%), and pouch-related fistulas (11.9%). Subsequent diffuse inflammation, pouch-related fistulas, and AL or IL stenoses significantly increased the pouch excision risk. Patients who achieved subsequent normal pouch were less likely to have pouch excision than those who did not (8.1% vs 15.7%; P = .15).
CONCLUSIONS: Pouch phenotype and the risk of pouch loss can change over time. In patients with pouch inflammation, subsequent pouch normalization is feasible and associated with favorable outcome.
Endoscopic pouch phenotypes can change over time and subsequent development of diffuse inflammation, pouch-related fistulas, and afferent limb/inlet stenoses significantly worsen pouch outcomes. In patients with pouch inflammation, subsequent pouch normalization is feasible and associated with favorable outcomes.