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Outcomes Following Pouch Formation in Paediatric Ulcerative Colitis: A Study From the Porto Group of ESPGHAN
Esther Orlanski-Meyer1, Chani Topf-Olivestone1, Oren Ledder1
1Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.
Insights
Pediatric ileal pouch-anal anastomosis shows high rates of pouchitis, but surgeon experience is a key factor for successful outcomes. Surgery is also safe and effective in younger children with ulcerative colitis or IBD-unclassified.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
- Inflammatory Bowel Disease Research
Background:
- Contemporary data on pediatric pouch outcomes are limited, particularly with the rise of laparoscopic techniques.
- Ulcerative colitis and IBD-unclassified necessitate colectomy and ileal pouch-anal anastomosis in pediatric patients.
Purpose of the Study:
- To assess pouch outcomes in children with ulcerative colitis/IBD-unclassified after colectomy and ileal pouch-anal anastomosis.
- To identify predictors of pouch outcomes in this pediatric population.
Main Methods:
- A multicenter retrospective cohort study involving 17 pediatric IBD centers.
- Data collected via an electronic REDcap system, including demographics, clinical details, management, surgical data, and short/long-term outcomes.
- Analysis focused on identifying predictors of pouch outcome.
Main Results:
- Out of 129 patients, 67% developed pouchitis, with 26% experiencing chronic pouchitis.
- Surgeons performing fewer than 10 pouch surgeries annually had higher rates of chronic pouchitis (41% vs 15%).
- Overall pouch performance was good/excellent in 74% of patients; younger children had more complications but similar functional outcomes and pouchitis rates.
Conclusions:
- Pouchitis rates are high in pediatric patients with ulcerative colitis/IBD-unclassified.
- Surgeon experience is a significant modifiable risk factor influencing pouch outcomes.
- Ileal pouch-anal anastomosis surgery can be successfully performed in younger children.
Introduction:
Contemporary pediatric data on pouch outcomes are sparse, especially in the era of laparoscopic surgeries. We aimed to assess outcomes and predictors in children with ulcerative colitis/inflammatory bowel disease (IBD)-unclassified who underwent colectomy and ileal pouch-anal anastomosis.
Methods:
This was a multicenter retrospective cohort study from 17 IBD centers affiliated with the pediatric IBD Porto group of ESPGHAN. An electronic REDcap system was used to collate baseline characteristics, demographic, clinical, management and surgical data, short- and long-term outcomes, and to identify potential predictors of pouch outcome.
Results:
Of the 129 patients included, 86 (67%) developed pouchitis during follow-up of median 40 months (interquartile range 26-72), of whom 33 (26%) with chronic pouchitis. Patients operated on by surgeons performing <10 pouch surgeries/year had a higher rate of chronic pouchitis (11/27 [41%] vs 8/54 [15%], P = 0.013) on both univariable and multivariable analyses and also associated with time to pouchitis (P = 0.018) and chronic pouchitis (P = 0.020). At last follow-up, overall pouch performance was rated good/excellent in 86 (74%) patients. Time from colectomy to pouch formation was not associated with pouch outcomes. Despite higher rate of nonsevere surgical complications among children undergoing colectomy at <10 years of age (7/16 [44%] vs 10/92 [11%], P = 0.003), functional outcome and pouchitis rate did not differ.
Conclusions:
Pouchitis rate in children with ulcerative colitis/IBD unclassified is high. Surgeon experience is the major modifiable risk factor for pouch outcome. Our analyses suggest that pouch surgery can also be performed successfully in young children.