Endoscopic Therapy for Pouch Leaks and Strictures: A Systematic Review

Area of Science:

• Gastroenterology and Surgery
• Minimally Invasive Procedures

Background:

• Ileal pouch-anal anastomosis (IPAA) is a surgical option for ulcerative colitis and familial adenomatous polyposis.
• Complications like pouch strictures and leaks can necessitate further intervention.
• Traditional surgical repair is invasive and costly, with limited medical treatment options for fibrotic strictures.

Approach:

• A systematic literature review was conducted using PubMed and Cochrane databases.
• Studies published between January 1990 and January 2022 were included, focusing on endoscopic management of IPAA leaks and strictures.
• Exclusion criteria included surgical management and non-adult IPAA pouches.

Key Points:

• Endoscopic therapies for IPAA leaks include clipping and endoscopic sinusotomy.
• For strictures, endoscopic balloon dilation, stricturotomy, and stricturoplasty are now first-line treatments.
• Balloon dilation is effective for simple strictures, while stricturotomy addresses complex, fibrotic ones.

Conclusions:

• Endoscopic therapies offer a less invasive and potentially cost-effective approach to managing IPAA complications.
• These techniques can delay or obviate the need for repeat surgeries.
• Successful outcomes depend on appropriate patient selection, endoscopist expertise, and surgical backup plans.