Post-index procedural gain in body mass index is associated with recurrent ileal pouch sinus after endoscopic or surgical therapy

Abstract

Ileal pouch-anal anastomosis has become thestandard surgical procedure for patients with ulcerative colitiswho require colectomy. Presacral sinus is a common complicationafter the surgery. Pouch sinus results from chronic anastomotic or suture line leak. An excessive gain in body mass index (BMI) has been shown to be associated with poor pouch outcome. The aim of this study was to evaluate whether an increase in BMI was associated with recurrences of chronic pouch sinus after endoscopic or surgical treatment. All consecutive ulcerative colitis patients with an ileal pouch sinus successfully treated with either endoscopic sinusotomy or redo surgery from 2006 to 2016 were identified from our IRB approved, prospectively maintained Pouch Registry. An excessive gain in BMI was defined as an increase in BMI ≥ 10% from the baseline of the initial endoscopic or surgical treatment. The primary outcome was sinus recurrence after initial complete healing. This study included a total of 171 patients. Sinus recurrence was seen in 48 (28.1%) patients. A higher rate of recurrence of sinus was found in patients with BMI gain (≥ 10%) (22.9% vs. 8.9%, p = 0.01). However, the recurrence-free survival in Kaplan-Meier analysis between the BMI gain and non-BMI gain groups was not statistically significant (p = 0.10). In multivariate analysis, excessive BMI gain [odds ratio (OR) 3.0, 95% confidence interval (CI) 1.0-9.0)] and Crohn's disease of the pouch (OR 2.9, 95% CI 1.0-8.1) were independently associated with sinus recurrence. The healing rate of recurrent sinus after subsequent endoscopic or surgical treatment was comparable between those who had an excessive increase in BMI and those who maintained a relatively stable weight (63.6% vs. 70.3%, p = 0.81). However, the recurrent presacral sinus-related pouch failure rate was numerically higher in patients with an excessive BMI gain (36.4% vs. 16.2%, p = 0.31). An excessive gain in BMI after initial successful pouch sinus treatment is associated with an increased risk for sinus recurrence. Weight control may help decrease the risk for recurrence of pouch sinus.