Diagnosis and classification of ileal pouch disorders: consensus guidelines from the International Ileal Pouch Consortium

Lancet Gastroenterol Hepatol. 2021 Oct;6(10):826-849.doi: 10.1016/S2468-1253(21)00101-1. Epub 2021 Aug 18.

Bo Shen 1, Gursimran S Kochhar 2, Revital Kariv 3, Xiuli Liu 4, Udayakumar Navaneethan 5, David T Rubin 6, Raymond K Cross 7, Akira Sugita 8, André D'Hoore 9, Jason Schairer 10, Francis A Farraye 11, Ravi P Kiran 12, Philip Fleshner 13, Joel Rosh 14, Samir A Shah 15, Shannon Chang 16, Ellen Scherl 17, Darrell S Pardi 18, David A Schwartz 19, Paulo G Kotze 20, David H Bruining 18, Sunanda V Kane 18, Jessica Philpott 21, Bincy Abraham 22, Jonathan Segal 23, Rocio Sedano 24, Maia Kayal 25, Stuart Bentley-Hibbert 26, Dino Tarabar 27, Sandra El-Hachem 2, Priya Sehgal 28, James T McCormick 29, Joseph A Picoraro 30, Mark S Silverberg 31, Charles N Bernstein 32, William J Sandborn 33, Séverine Vermeire 34


Author information

1Center for Interventional Inflammatory Bowel Disease, Columbia University Irving Medical Center-New-York Presbyterian Hospital, NY, USA. Electronic address: bs3270@cumc.columbia.edu.

2Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA.

3Department of Gastroenterology, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

4Department of Pathology and Immunology, Washington University, MO, USA.

5IBD Center and IBD Interventional Unit, Center for Interventional Endoscopy, Orlando Health, Orlando, FL, USA.

6Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.

7Inflammatory Bowel Disease Program, University of Maryland School of Medicine, Baltimore, MD, USA.

8Department of Clinical Research and Department of Inflammatory Bowel Disease, Yokohama Municipal Citizens Hospital Yokohama, Japan.

9Department of Abdominal Surgery, University Hospital Leuven, Belgium.

10Department of Gastroenterology, Henry Ford Health System, Detroit, MI, USA.

11Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA.

12Division of Colorectal Surgery, Columbia University Irving Medical Center-New-York Presbyterian Hospital, NY, USA.

13Division of Colorectal Surgery, University of California-Cedars Sinai Medical Center, Los Angeles, CA, USA.

14Department of Pediatric Gastroenterology, Goryeb Children's Hospital-Atlantic Health, Morristown, NJ, USA.

15Alpert Medical School of Brown University and Miriam Hospital, Gastroenterology Associates, Providence, RI, USA.

16Division of Gastroenterology, New York University Langone Health, New York, NY, USA.

17New York Presbyterian Hospital, Jill Roberts Center for IBD, Weill Cornell Medicine, Gastroenterology and Hepatology, New York, NY, USA.

18Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.

19Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, TN, USA.

20IBD Outpatients Clinic, Catholic University of Paraná, Curitiba, Brazil.

21Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA.

22Houston Methodist and Weill Cornell Medical College, Houston, TX, USA.

23Department of Gastroenterology and Hepatology, Hillingdon Hospital, Uxbridge, UK.

24Department of Medicine, Division of Gastroenterology, Western University, London, ON, Canada.

25Department of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.

26Department of Radiology, Columbia University Irving Medical Center-New-York Presbyterian Hospital, NY, USA.

27IBD Clinical Center, University Hospital Center Dr Dragiša Mišovic, Belgrade, Serbia.

28Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New-York Presbyterian Hospital, NY, USA.

29Division of Colon and Rectal Surgery, Allegheny Health Network, Pittsburgh, PA, USA.

30Department of Pediatrics, Columbia University Irving Medical Center-Morgan Stanley Children's Hospital, New York, NY, USA.

31Mount Sinai Hospital Inflammatory Bowel Disease Centre, Toronto, ON, Canada.

32Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.

33Department of Gastroenterology, University of California San Diego, San Diego, CA, USA.

34Department of Gastroenterology, University hospitals Leuven, Leuven, Belgium.


Restorative proctocolectomy with ileal pouch-anal anastomosis is an option for most patients with ulcerative colitis or familial adenomatous polyposis who require colectomy. Although the construction of an ileal pouch substantially improves patients' health-related quality of life, the surgery is, directly or indirectly, associated with various structural, inflammatory, and functional adverse sequelae. Furthermore, the surgical procedure does not completely abolish the risk for neoplasia. Patients with ileal pouches often present with extraintestinal, systemic inflammatory conditions. The International Ileal Pouch Consortium was established to create this consensus document on the diagnosis and classification of ileal pouch disorders using available evidence and the panellists' expertise. In a given individual, the condition of the pouch can change over time. Therefore, close monitoring of the activity and progression of the disease is essential to make accurate modifications in the diagnosis and classification in a timely manner.

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