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Diagnosis and Treatment of Pouch Disorders in Children: A Systematic Review
Padmini Nallapaneni1, Joseph A Picoraro
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York.
Insights
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is common in children. This review highlights the varied diagnosis and treatment of pouch disorders in pediatric patients, emphasizing the need for more pediatric-specific research.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Inflammatory bowel disease
Background:
- Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) are standard surgical options for pediatric patients with severe colitis or familial adenomatous polyposis.
- IPAA is increasingly utilized in pediatric care for complex gastrointestinal conditions.
Conclusions:
- Current management strategies for pediatric pouch disorders are largely extrapolated from adult data, with limited evidence on treatment efficacy in children.
- There is a critical need for multicenter prospective studies to standardize assessment, identify pediatric-specific risk factors, and develop effective treatment protocols.
- Further research is essential to optimize outcomes for pediatric patients undergoing IPAA.
Background:
Restorative proctocolectomy and IPAA have become the surgical procedure of choice in pediatric patients with medically refractory colitis or familial adenomatous polyposis.
Objective:
This systematic review aims to assess the diagnosis and treatment of pouch disorders in pediatric patients who undergo IPAA.
Data Sources:
A literature search was performed using MEDLINE, Google Scholar, and Embase for all publications describing outcomes of pediatric IPAA.
Study Selection:
Studies between January 1, 2000, and September 7, 2022, published in English were included. Studies were excluded on the basis of title, abstract, and full-length review.
Interventions:
IPAA.
Main Outcome Measures:
Pouch disorders described include anastomotic leaks, pouch strictures, pouch failure, pouchitis, cuffitis, and de novo Crohn's disease of the pouch.
Results:
Thirty-three studies were included in this review, all of which were retrospective in nature. The outcomes of 2643 pediatric patients were included in the 33 studies.
Limitations:
Management is largely informed by clinical practices in adult patients with scant data on treatment efficacy in children.
Conclusions:
The reported incidence of disorders of the pouch in children varies widely and is likely attributable to differences in definitions and follow-up periods across studies. Pouchitis was the most frequently described outcome. The overall rate of pouch failure in children is relatively low, with de novo Crohn's disease of the pouch being the most significant risk factor. Multicenter prospective studies are needed in the pediatric population to accurately identify risk factors, standardize the assessment of pouch complications, and determine effective treatment strategies. See video from the symposium .
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