Open AccessOutcomes Following Pouch Formation in Paediatric Ulcerative Colitis
Author(s) -
OrlanskiMeyer Esther,
TopfOlivestone Chani,
Ledder Oren,
Dotan Iris,
FolmerHansen Lars,
Kindermann Angelika,
Assa Amit,
Kolho KaijaLeena,
Kolaček Sanja,
Carroll Matthew W.,
Strisciuglio Caterina,
Aloi Marina,
Hansen Richard,
Navon Dan,
Winter Harland S.,
NavasLópez Victor M.,
Ridder Lissy,
Smets Françoise,
Weiss Batia,
Turner Dan
Publication year - 2020
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000002805
Subject(s) - pouchitis , medicine , ulcerative colitis , pouch , colectomy , interquartile range , inflammatory bowel disease , anastomosis , retrospective cohort study , gastroenterology , cohort , surgery , disease
Contemporary pediatric data on pouch outcomes are sparse, especially in the era of laparoscopic surgeries. We aimed to assess outcomes and predictors in children with ulcerative colitis/inflammatory bowel disease (IBD)‐unclassified who underwent colectomy and ileal pouch‐anal anastomosis. Methods: This was a multicenter retrospective cohort study from 17 IBD centers affiliated with the pediatric IBD Porto group of ESPGHAN. An electronic REDcap system was used to collate baseline characteristics, demographic, clinical, management and surgical data, short‐ and long‐term outcomes, and to identify potential predictors of pouch outcome. Results: Of the 129 patients included, 86 (67%) developed pouchitis during follow‐up of median 40 months (interquartile range 26–72), of whom 33 (26%) with chronic pouchitis. Patients operated on by surgeons performing <10 pouch surgeries/year had a higher rate of chronic pouchitis (11/27 [41%] vs 8/54 [15%], P = 0.013) on both univariable and multivariable analyses and also associated with time to pouchitis ( P = 0.018) and chronic pouchitis ( P = 0.020). At last follow‐up, overall pouch performance was rated good/excellent in 86 (74%) patients. Time from colectomy to pouch formation was not associated with pouch outcomes. Despite higher rate of nonsevere surgical complications among children undergoing colectomy at <10 years of age (7/16 [44%] vs 10/92 [11%], P = 0.003), functional outcome and pouchitis rate did not differ. Conclusions: Pouchitis rate in children with ulcerative colitis/IBD unclassified is high. Surgeon experience is the major modifiable risk factor for pouch outcome. Our analyses suggest that pouch surgery can also be performed successfully in young children.