- Fecal Incontinence
|Management of pouch neoplasia: consensus guidelines from the International Ileal Pouch Consortium
Lancet Gastroenterol Hepatol. 2022 Sep;7(9):871-893.doi: 10.1016/S2468-1253(22)00039-5. Epub 2022 Jul 5.
Ravi P Kiran 1, Gursimran S Kochhar 2, Revital Kariv 3, Douglas K Rex 4, Akira Sugita 5, David T Rubin 6, Udayakumar Navaneethan 7, Tracy L Hull 8, Huaibin Mabel Ko 9, Xiuli Liu 10, Lisa A Kachnic 11, Scott Strong 12, Marietta Iacucci 13, Willem Bemelman 14, Philip Fleshner 15, Rachael A Safyan 16, Paulo G Kotze 17, André D'Hoore 18, Omar Faiz 19, Simon Lo 20, Jean H Ashburn 21, Antonino Spinelli 22, Charles N Bernstein 23, Sunanda V Kane 24, Raymond K Cross 25, Jason Schairer 26, James T McCormick 27, Francis A Farraye 28, Shannon Chang 29, Ellen J Scherl 30, David A Schwartz 31, David H Bruining 24, Jessica Philpott 32, Stuart Bentley-Hibbert 33, Dino Tarabar 34, Sandra El-Hachem 2, William J Sandborn 35, Mark S Silverberg 36, Darrell S Pardi 24, James M Church 1, Bo Shen 37
1Division of Colorectal Surgery, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA.
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.
4Indiana University School of Medicine, Indianapolis, IN, USA.
5Department of Clinical Research and Department of inflammatory Bowel Disease, Yokohama Municipal Citizens Hospital Yokohama, Japan.
6University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA.
7IBD Center and IBD Interventional Unit, Center for Interventional Endoscopy, Orlando Health, Orlando, FL, USA.
8Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA.
9Department of Pathology and Cell Biology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA.
10Department of Pathology and Immunology, Washington University, St Louis, MO, USA.
11Department of Radiation Oncology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA.
12Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
13Institute of Immunology and Immunotherapy, NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust, University of Birmingham, UK.
14Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
15Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
16Division of Hematology and Oncology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
17IBD Outpatients Clinic, Catholic University of Paraná, Curitiba, Brazil.
18Department of Abdominal Surgery, University Hospital Leuven, Belgium.
19Department of Surgery, St Mark's Hospital and Academic Institute, Harrow and Department of Surgery and Cancer, Imperial College London, London, UK.
20Pancreatic and Biliary Disease Program, Digestive Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA.
21Department of Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
22Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Division Colon and Rectal Surgery, Rozzano, Milan, Italy.
23University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, MB, Canada.
24Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
25Inflammatory Bowel Disease Program, University of Maryland School of Medicine, MD, USA.
26Department of Gastroenterology, Henry Ford Health System, Detroit, MI, USA.
27Division of Colon and Rectal Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
28Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA.
29Inflammatory Bowel Disease Center, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA.
30Jill Roberts Center for IBD, Gastroenterology and Hepatology, Weill Cornell Medicine and NewYork Presbyterian Hospital, New York, NY, USA.
31Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, TN, USA.
32Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA.
33Department of Radiology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA.
34IBD Clinical Center, University Hospital Center Dr Dragiša Mišovic, Belgrade, Serbia.
35Department of Medicine, University of California San Diego, San Diego, CA, USA.
36Mount Sinai Hospital Inflammatory Bowel Disease Centre, Toronto, ON, Canada.
37Center for Interventional Inflammatory Bowel Disease, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA. Electronic address: email@example.com.
Surveillance pouchoscopy is recommended for patients with restorative proctocolectomy with ileal pouch-anal anastomosis in ulcerative colitis or familial adenomatous polyposis, with the surveillance interval depending on the risk of neoplasia. Neoplasia in patients with ileal pouches mainly have a glandular source and less often are of squamous cell origin. Various grades of neoplasia can occur in the prepouch ileum, pouch body, rectal cuff, anal transition zone, anus, or perianal skin. The main treatment modalities are endoscopic polypectomy, endoscopic ablation, endoscopic mucosal resection, endoscopic submucosal dissection, surgical local excision, surgical circumferential resection and re-anastomosis, and pouch excision. The choice of the treatment modality is determined by the grade, location, size, and features of neoplastic lesions, along with patients' risk of neoplasia and comorbidities, and local endoscopic and surgical expertise.