Management of early pouch-related septic complications in ulcerative colitis: a systematic review

AIM: It is well established that ileo-anal pouch-related septic complications (PRSC) increase the risk of pouch failure. There are a number of publications that describe the management of early PRSC in ulcerative colitis (UC) in small series. This article aims to systematically review and summarize the relevant current data on this subject and provide an algorithm for the management of early PRSC. METHOD: A systematic review was undertaken in accordance with PRISMA guidelines. Studies published between 2000 and 2017 describing the clinical management of PRSC in patients with UC within 30 days of primary ileo-anal pouch surgery were included. A qualitative analysis was undertaken due to the heterogeneity and quality of studies included. RESULTS: A total of 1157 abstracts and 266 full text articles were screened. Twelve studies were included for analysis involving a total of 207 patients. The studies described a range of techniques including image-guided, endoscopic, surgical and endocavitational vacuum methods. Based on the evidence from these studies, an algorithm was created to guide the management of early PRSC. CONCLUSION: The results of this review suggest that although successful salvage of early PRSC is improving there is little information available relating to methods of salvage and outcomes. Novel techniques may offer an increased chance of salvage but comparative studies with longer follow-up are required

Biological therapy for the treatment of prepouch ileitis: a retrospective observational study from three centers

Jonathan P Segal,1,2 Matteo Rottoli,3 Richard K Felwick,4 Guy HT Worley,1,2 Simon D McLaughlin,4 Carlo Vallicelli,3 Paul Bassett,5 Omar D Faiz,1,2 Ailsa L Hart,1,2 Susan K Clark1,2 1Inflammatory Bowel Disease Department, St Mark’s Hospital, Harrow, UK; 2Department of Surgery and Cancer, Imperial College, London, UK; 3Surgery of the Alimentary Tract, Sant’Orsola – Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy; 4Department of Gastroenterology, The Royal Bournemouth and Christchurch Hospitals, Bournemouth, UK; 5Statsconsultancy Ltd, Amersham, UK Aim: Prepouch ileitis (PPI) is inflammation of the ileum proximal to an ileoanal pouch, usually associated with pouchitis. The treatment of PPI as a specific entity has been poorly studied, but it is generally treated concurrently with pouchitis. This to our knowledge is the largest study to explore the efficacy of biologics for the specific treatment of PPI.Methods: This was a retrospective observational study reporting outcomes following biological treatment in patients with PPI across three centers. Data were collected between January 2004 and February 2018 from two centers in the UK and one center in Italy. Outcomes included the continued presence of PPI following biologic therapy, pouch failure defined by the need for an ileostomy, and remission of PPI defined by the absence of any prepouch inflammation on endoscopic assessment within a year of biologic therapy.Results: There were 29 patients in our cohort. On last endoscopic follow-up, 20/29 still had endoscopic evidence of PPI, seven had achieved endoscopic remission and avoided an ileostomy, and two had no endoscopic follow-up. In our cohort 11 patients had an ileostomy after a median time from starting a biologic of 25 months (range 14–91).Conclusion: Biologics fail to induce endoscopic remission of PPI in the majority of patients. Just under one-third patients with PPI coexistent with pouchitis can achieve endoscopic remission with biologics. In a large proportion of patients with PPI, surgery may be required despite biologic use. Keywords: pouch, biologics, prepouch ileitis, pouchitis, restorative proctocolectomy, infliximab&nbsp