Pouch Wall Thickness and Floppy Pouch Complex

Abstract

Introduction: Floppy pouch complex (FPC) consists of disease phenotypes in patients with ileal pouches, including pouch prolapse, afferent limb syndrome, enterocele, redundant loop, and pouch folding (Figure 1). The main symptoms of patients with FPC are dyschezia, incomplete evacuation, and bloating. Our recent study demonstrated that lower body weight, lower peripouch fat, family history of IBD, female gender, and dyschezia are risk factors for FPC patients with inflammatory bowel disease (IBD). The aim of the study was to investigate the relationship between FPC and pouch wall thickness.691_A Figure 1. Categorical analysis of FPC and pouch wall thickness.Methods: This case-control study included all eligible patients with FPC from our prospectively maintained, IRB-approved Pouchitis Registry from 2011 to 2017. We measured pouch wall thickness on fully distended pouches on cross-sectional imaging. Patients with stoma or non-distended pouches were excluded. Categorical analysis was performed to explore risk factors of FPC. Results: A total of 140 out of 451 patients from our Pouch Database found to have fully distended pouches on imaging. Of the 140, 32 (22.9%) patients had diagnoses of FPC. Out of 32 patients in study group, 14 (43.8%) were female and 11 (34.4%) had smoking history. Eight (25.0%) patients had history of excessive alcohol consumption. Three (9.4%) patients had extra-intestinal manifestations (EIM) of IBD. Thirteen (40.6%) patients had family history of IBD. Twenty eight (87.5%) patients had j-pouch and 1 (3.1%) had an s pouch. Seven (21.9%) patients underwent 1-stage pouch surgery, 16 (50.0%) had 2- stage pouch surgery, 9 (28.1%) had 3-stage pouch surgery. Patients were further categorized based on pouch wall thickness: 21 (65.6%) patients had 1-1.9 mm pouch wall thickness; 8 (25.0%) had 2-2.9mm; and 3 (9.4%) had 3-3.9mm thick pouch wall. The control group of 106 patients without FPC was also divided into 3 subgroups based on the pouch wall thickness: 47 (44.3%) had 1-1.9 mm; 50 (47.2%) had 2-2.9mm; and 9 (8.5%) 3-3.9mm. Statistical analysis showed that patients with a pouch wall thickness of 1-1.9 mm and 2-2.9 mm were shown to have a higher incidence of FPC (65.6% vs. 44.3%, p = 0.04; 25.0% vs. 47.3%, p = 0.03) than controls (Table 1). Conclusion: This study showed that patients with thin pouch wall tend to have a higher risk of FPC. These findings will have implications in both diagnosis and investigation of etiopathogenesis of this group of challenging disorders.