POUCHOSCOPY AS A USEFUL TOOL FOR THE DIAGNOSIS AND TREATMENT OF PATIENTS WITH IPAA

Aims Pouchoscopy is a useful tool for the study of patients operated with total colectomy and ileal pouch anal anastomosis (IPAA). It can be used either for the diagnosis of pouchitis in combination with clinical presentation and histology or for endoscopic interventions if post surgery complications appear.

Methods We present retrospectively data from pouchoscopies in patients operated with IPAA over a follow up period of 15 years. The main indications of endoscopy were diarrhea with/no blood, increased bowel frequency, incomplete evacuation, anal pain and nocturnal seepage. The pouchoscopy was performed through flexible sigmoidoscope or gastroscope after suitable preparation and following data were collected: time since temporary loop closure, endoscopic findings (pouchitis, stricture, abcess). The offered treatment was either conservative (antibiotics, anti–inflammatory drugs, antidiarrheals, probiotics) or intervantional (digital/ballon/bougie dilatation).

Results A total of 110 pouchoscopies were performed in 90 patients. The endoscopic findings were 45 cases with pouchitis, 38 with pouch outlet strictures, 15 with inlet pouch strictures and 21 with pouch related fistulas. We present the management and outcome of each case.

Conclusions Pouchoscopy remains the basic instrument for diagnosis of post IPAA pouch related complications. In combination with radiology imaging it can result in a safe therapeutic tool for the solution ileal pouch disorders eliminating the number of surgical interventions in this particular group of patients.