OP15 ECCO Topical Review on Pouch Disorders

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Abstract Background Pouch disorders are common and may present with symptoms of increased stool frequency, urgency, incontinence, pelvic cramping, and perianal drainage, leading to poor sleep, fatigue, and disability. This topical review provides expert consensus recommendations for the diagnosis and management of the most common inflammatory, functional, structural and neoplastic pouch disorders. Methods An open-call for participation was made to all ECCO members. Four working groups were formed each focusing on a specific category of pouch disorders. Each group member performed a comprehensive literature review for their assigned disorder using appropriate key words and drafted summary texts. Sections were reviewed and integrated into a single manuscript by MK, GB, and MF. Results Symptoms that arise and persist immediately following pouch construction may indicate surgical issues, while those that gradually develop after a prolonged period of wellness may suggest inflammatory or functional disorders. Symptoms of increased stool frequency, abdominal cramping, and urgency are suggestive of an inflammatory disorder, and a short trial of oral antibiotics may confirm the most likely diagnosis of pouchitis, though a pouchoscopy is preferable to exclude other causes. In case of persistent or recurrent symptoms of pouchitis, additional evaluation via stool studies, pouchoscopy and cross-sectional imaging should be considered to rule out chronic antibiotic-dependent or –refractory pouchitis, or Crohn’s-like disease of the pouch. Symptoms of chronic pelvic pain, intermittent obstruction, and incomplete evacuation suggest a structural disorder. Evaluation with pouchography, MR defaecography, pouchoscopy and examination under anaesthesia should be performed to evaluate for pouch prolapse or volvulus, afferent or efferent limb syndrome, anastomotic leakage, strictures or fistulae. Symptoms of incomplete evacuation, incontinence, and pelvic pain that occur in the absence of an inflammatory or structural abnormality point to a functional disorder. Assessment with anorectal manometry, balloon expulsion tests, and defaecography should be conducted to evaluate pelvic floor dynamics and rule out pelvic floor dyssynergia or irritable pouch syndrome. Conclusion A multidisciplinary approach is essential for the diagnosis and management of most pouch disorders. Centres with a specialized pouch care team are often best equipped to manage these complex cases, providing the expertise necessary for accurate diagnosis and tailored interventions.