| Risk of cancer in patients with chronic pouchitis after restorative proctocolectomy for ulcerative colitis. | |
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MedLine Citation:
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PMID: 19832871 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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AIM: The aim of this study was to evaluate the consequences of chronic pouchitis after restorative proctocolectomy for ulcerative colitis. METHOD: Forty-two patients with chronic pouchitis underwent pouch endoscopy with biopsies after a median of 8.3 years of postoperative follow up. The pouchitis disease activity index (PDAI) was calculated. Morphological changes were recorded. Immunohistochemical analyses for cyclooxygenase 2 (COX-2), Ki-67 and p53 were performed, as was DNA flow cytometry. Endoscopy was also carried out in 10 patients without pouchitis and in nine healthy subjects. RESULTS: In patients with chronic pouchitis, the PDAI was 6 (standard error of the mean ± 4). Eighteen (43%) patients used continuous medication. The PDAI correlated positively with villous atrophy (P < 0.05). None of the pouch biopsies showed dysplasia. COX-2 immunostaining was detected in 35 (83.3%) patients with chronic pouchitis, in five (50%) without pouchitis, but in none of the normal controls. COX-2 expression correlated with mucosal atrophy (P < 0.01). In 15 (35.7%) of 42 patients with chronic pouchitis, Ki-67 immunostaining was increased, but no increase was observed in either control group (P < 0.002). No p53 immunopositivity was found, and DNA flow cytometry was normal in all pouches. One of the patients developed adenocarcinoma at the anal anastomosis. CONCLUSION: No dysplastic changes were detected during the first decade after surgery. Routine follow up of patients with chronic pouchitis with a hand-sewn anastomosis may not be necessary, although a small risk of cancer seems to remain at the anal anastomosis. The follow up should be focused on at-risk groups. |
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Authors:
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P Vento; A Lepistö; P Kärkkäinen; A Ristimäki; C Haglund; H J Järvinen |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland Volume: 13 ISSN: 1463-1318 ISO Abbreviation: Colorectal Dis Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2010-12-24 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100883611 Medline TA: Colorectal Dis Country: England |
Other Details:
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Languages: eng Pagination: 58-66 Citation Subset: IM |
Copyright Information:
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© 2010 The Authors. Colorectal Disease © 2010 The Association of Coloproctology of Great Britain and Ireland. |
Affiliation:
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Department of Surgery, Central Hospital of Kymenlaakso, Kotka, Finland. palvi.vento@kymshp.fi |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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