Colectomy For Ulcerative Colitis Research Articles

Sa1969 - Anti-TNF Therapy in Refractory Pouchitis and Crohn's Disease-Like Complications of the Pouch after Ileal Pouch-Anal Anastomosis following Colectomy for Ulcerative Colitis: A Systematic Review and Meta-Analysis

Sa1969 - Anti-TNF Therapy in Refractory Pouchitis and Crohn's Disease-Like Complications of the Pouch after Ileal Pouch-Anal Anastomosis following Colectomy for Ulcerative Colitis: A Systematic Review and Meta-Analysis

Systematic Review : The Burden of Post-Operative Complications Following Colectomy for Ulcerative Colitis

Background: Ulcerative colitis (UC) patients failing medical management require colectomy. Methods:Literature search in MEDLINE , CINAHL and Embase, targeting studies reporting the outcomes of colorectal procedures (from 2002 to 2016 with total and subtotal colectomy postoperative complications in adults with ulcerative colitis as an endpoint. Texts and authoritative Web sites were also reviewed then identification of papers according to the inclusion and exclusion criteria and data extraction were performed by two independent researchers. Results:Following data extraction and synthesis, we identified 24 articles for review. Reporting outcomes from procedures conducted from 2002–2016. Most frequent short-term complications: infectious complications and ileus (mean incidence 21% and 19%), while most frequent long-term complications: pouchitis, fecal incontinence and small bowel obstruction (mean incidence 31%, 22% and 18%). Post-operative early complications (≤30 days) occurred in 18–63% of patients with ulcerative colitis while late complications (>30 days) occurred in 19–58% of patients. Rates of early infection and late pouch failure decreased significantly from 2002 to 2015 (22% to 2% respectively). Conclusion:although Colectomy remains an appropriate therapeutic strategy for specific groups of patients- it is not the optimal cure for UC. Clinicians need to fully understand the various postoperative complications and comorbidities that are highly prevalent with over a third of patients expected to experience long-term or late arising post-operative complications. Thus, while surgical procedures are recommended as an appropriate therapeutic strategy for a specific group of patients, the post-operative complications associated with these surgical procedures should not be underestimated.

P628 Anti-TNF therapy in refractory pouchitis and Crohn's disease-like complications of the pouch after ileal pouch-anal anastomosis following colectomy for ulcerative colitis: a systematic review and meta-analysis

P628 Anti-TNF therapy in refractory pouchitis and Crohn's disease-like complications of the pouch after ileal pouch-anal anastomosis following colectomy for ulcerative colitis: a systematic review and meta-analysis

P607 Post-operative mortality and predictive factors in a cohort of severe refractory ulcerative colitis patients from the ENEIDA Registry (1989–2013): a multicenter nationwide study

Background: Meta-analysis from population-based studies report mortality rates associated to colectomy in ulcerative colitis (UC) around 5% while the reported rate in tertiary centers is close to 0%. However, little is known about factors related to post-operative mortality in the subpopulation of patients with severe refractory (SR-UC). Aim: to evaluate the mortality rate over time together with related factors in patients requiring colectomy due to SR-UC. Methods: Patients requiring colectomy due to SR-UC from 22 Spanish hospitals adhered to the ENEIDA Registry from 1989 to 2013 have been included. In addition, all investigators reviewed their hospital discharge registries using “colitis” and “colectomy” as search terms. The following variables have been analyzed: age, gender, disease duration and extent, rescue medical therapies, type of surgery (urgent vs elective; open vs laparoscopic), hospital complexity (tertiary vs secondary) and period (1989–2001 vs 2002–2013). Percentages were compared using the χ2 or Fisher exact test as appropriate. Logistic regression analysis was used to evaluate predictive factors of death. Results: A total of 424 patients have been included (253 male, age 42.3±16.4 years). Mortality rate associated to SR-UC flare was 6.4% (N=27/424). Causes of death were: infection 11, post-colectomy perforation 6, hemorrhage 4, multiorganic failure 4, others 2. Univariate analysis showed higher mortality in patients older than 50 years (p<0.0001) and in urgent colectomy (p<0.001). Colectomy rate was lower if SR-UC presented at diagnosis (p=0.02), it if was treated in tertiary centers (p=0.006) and in patients that received rescue medical treatment (p<0.001). There were no differences in mortality between periods (9.3% vs 4.8%; p=0.069). An age >50 [OR 26.0 (7.2–93.4)] and urgent colectomy [OR 13.2 (1.6–104.2)] were predictive factors of mortality whereas to be colectomized in a tertiary center [OR 0.2 (0.08–0.9)], after 2002 [OR 0.3 (0.1–0.9)] and to have a SR-UC at diagnosis [OR 0.1 (0.03–0.7)] reduced the risk independently. Conclusions: Age, as surrogate marker of comorbidity, is the strongest factor related to post-operative mortality in SR-UC. Patients with SR-UC requiring colectomy should be operated in tertiary hospitals.

Risk for Cancer Progression in Ulcerative Colitis with Low-Grade Dysplasia

In the past, multifocal low-grade dysplasia (LGD) verified by an expert pathologist was considered an indication for colectomy in ulcerative colitis,

Increased Risk of Gallstone Disease Following Colectomy for Ulcerative Colitis.

Biochemical studies suggest that patients who have had a colectomy or restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) are at an increased risk of developing gallstone disease, but epidemiological studies are lacking. We evaluated the risk of gallstone disease following colectomy and IPAA. Individuals who had a colectomy were identified from a national cohort of patients with ulcerative colitis (UC), and controls without colectomy were sampled from within the same cohort, matching on gender, calendar year, and year of birth. We used Cox regression to examine the effect of colectomy on the hazard rates of gallstone disease and cholecystectomy, adjusting for alcoholism, stroke, chronic obstructive pulmonary disease, cancer, cardiac disease, diabetes mellitus, hypothyroidism, hyperlipidemia, cirrhosis, obesity, renal failure, and transient ischemic attacks. The effect of an IPAA was determined for patients who had colectomy by including the procedure as a time-dependent variable. We identified 4548 patients and matched these to 44 372 controls without colectomy. During a median follow-up of 11.9 years, 1963 patients were hospitalized for gallstone disease. Patients who had a colectomy were at an increased risk (adjusted hazard ratio (HR)=1.63 (1.39-1.91)), and sensitivity analyses of the risk of undergoing cholecystectomy revealed a similar association (adjusted HR=1.55 (1.22-1.98)). An IPAA did not affect the risk of developing gallstones among patients who had a colectomy (adjusted HR=1.03 (0.77-1.37)). The risk of gallstone disease increases following colectomy for UC.

Survival of ileal pouch anal anastomosis constructed after colectomy or secondary to a previous ileorectal anastomosis in ulcerative colitis patients: a population-based cohort study

Objectives: Ileorectal anastomosis (IRA) affects bowel function, sexual function and reproduction less negatively than ileal pouch anal anastomosis (IPAA), the standard reconstruction after colectomy for ulcerative colitis (UC). In younger UC patients, IRA may have a role postponing pelvic surgery and IPAA. The aim of the present study was to investigate the survival of IPAA secondary to IRA compared to IPAA as primary reconstruction, as this has not previously been studied in UC.Patients and methods: All patients with UC diagnosis between 1960 and 2010 in Sweden were identified from the National Patient Registry. From this cohort, colectomized patients reconstructed with primary IPAA and patients reconstructed with IPAA secondary to IRA were identified. The survival of the IPAA was followed up until pouch failure, defined as pouchectomy and ileostomy or a diverting ileostomy alone.Results: Out of 63,796 patients, 1796 were reconstructed with IPAA, either primarily (n = 1720) or secondary to a previous IRA (n = 76). There were no demographic differences between the groups, including length of follow-up (median 12.6 (IQR 6.7–16.6) years and 10.0 (IQR 3.5–15.9) years, respectively). Failure of the IPAA occurred in 103 (6.0%) patients with primary and in 6 (8%) patients after secondary IPAA (P = 0.38 log-rank). The 10-year pouch survival was 94% (95% CI 93–96) for primary IPAA and 92% (81–97) for secondary.Conclusions: Patients choosing IRA as primary reconstruction do not have an increased risk of failure of a later secondary IPAA in comparison with patients with primary IPAA.

大腸全摘術後に小腸出血を繰り返した潰瘍性大腸炎の1例

大腸全摘術後に小腸出血を繰り返した潰瘍性大腸炎の1例

East Meets West: The Increasing Incidence of Inflammatory Bowel Disease in Asia as a Paradigm for Environmental Effects on the Pathogenesis of Immune-Mediated Disease

East Meets West: The Increasing Incidence of Inflammatory Bowel Disease in Asia as a Paradigm for Environmental Effects on the Pathogenesis of Immune-Mediated Disease

Systematic review: outcomes and post-operative complications following colectomy for ulcerative colitis.

Colectomy for ulcerative colitis is associated with short- and long-term complications. Estimates of the frequency of such complications are variable and may have changed since the introduction of biological therapy. Understanding the true burden of surgical complications is important to clinicians in assessing risks and benefits of colectomy vs. continued medical therapy. To ascertain the outcomes of colectomy and ileal pouch surgery in patients with ulcerative colitis in the biologics era. Embase, MEDLINE and The Cochrane Library were searched for studies (2002-2015) reporting the outcomes of colorectal procedures (total and subtotal colectomy, IPAA with J-, S-, W-pouch) in adults with ulcerative colitis. Conferences proceedings (2011-2015) were hand-searched. We identified 28 studies (20,801 patients) reporting outcomes from procedures conducted from 2002-2015. Early complications (≤30days post-operatively), reported in 10 studies, occurred in 9-65% of patients with ulcerative colitis; late complications (>30days post-operatively) occurred in 17-55% of patients. Most frequent short-term complications: infectious complications and ileus (mean incidence 20% and 18%). Most frequent long-term complications: pouchitis, faecal incontinence and small bowel obstruction (mean incidence 29%, 21% and 17%). Rates of early infection and late pouch failure decreased from 22% and 13% in 2002-2009 to 11% and 2% in 2010-2015. The mean incidence of post-operative mortality was 1.0% across 11 studies. Early and late complications arise in about one-third of patients undergoing surgery for ulcerative colitis. While colorectal surgical procedures are recommended for a specific group of patients, the post-operative complications associated with these procedures should not be underestimated.

PTU-052 The Impact of Thiopurines on Risk of Intestinal Surgery in Elderly-Onset IBD: Abstract PTU-052 Table 1

Introduction Thiopurines (TP) have an established role in the maintenance of steroid-free remission in IBD. Their role in reducing the need for surgery in younger populations has been recently highlighed. 1 TPs are associated with an increased risk of lymphoma in the elderly but their role in reducing the risk of surgery in patients with elderly-onset IBD (EO-IBD) is not established. We therefore aimed to evaluate the impact of TPs on the risk of surgery in EO-IBD, using a nationally representative research database. Methods This was a retrospective descriptive study using data from the Clinical Practice Research Datalink (CPRD). Incident cases of IBD were isolated using previously validated Read codes. Patients were included if they had codes for ulcerative colitis (UC) or Crohn’s disease (CD), and their date of diagnosis was on/after their 60 th birthday. Information extracted included sex, age at diagnosis, smoking status, and prescription data for IBD medications. Finally, we obtained data on our main outcomes: colectomy in UC and first intestinal surgery in CD. A multivariate Cox proportional hazard model was generated to deduce the risk of surgery according to TP use. The model was adjusted for potential confounders including sex, smoking, 5 ASA use and early steroid use (corticosteroid within 3 months of diagnosis). In a subgroup of TP users, a second proportional hazard model was used to define the impact of duration of TP treatment on the risk of surgery. Results 2758 and 1349 were identified with EO-UC and EO-CD respectively, with a mean follow up of 4.9 years. Mean age at diagnosis was 71.8 years. Table 1 demonstrates the summary demographic and prescription data for both groups. TP use was associated with an increased risk of colectomy in EO-UC (HR 3.5, CI 2.28–5.35, p Conclusion TP use for longer than 12 months is associated with a reduced risk of colectomy in EO-UC but in contrast does not appear appear to impact on the risk of first intestinal surgery in EO-CD. This is an important observation since the risk of TP-associated lymphoma is substantially increased in this age group. Further work is needed to evaluate the role of TPs in EO-IBD. Reference 1 Chhaya V, et al . Impact of early thiopurines in 2770 children and young people diagnosed with IBD: a national population-based study. Aliment Pharmacol Ther . 2015 Oct; 42 (8). Disclosure of Interest C. Alexakis: None Declared, S. Saxena Grant/research support from: SS is funded by a National Institute for Health Research Career Development Fellowship (NIHR CDF-2011-04-048). The views expressed are not necessarily those of the NHS, NIHR, or Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript, V. Chhaya: None Declared, E. Cecil Grant/research support from: EC is funded by a National Institute for Health Research Career Development Fellowship (NIHR CDF-2011-04-048). The views expressed are not necessarily those of the NHS, NIHR, or Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript, R. Pollok: None Declared

Sa1901 Rates of Colectomy in Ulcerative Colitis (UC) Through Time in a Latin-American Unit of IBD

Sa1901 Rates of Colectomy in Ulcerative Colitis (UC) Through Time in a Latin-American Unit of IBD

Da Vinci Total Abdominal Colectomy for Ulcerative Colitis

Da Vinci Total Abdominal Colectomy for Ulcerative Colitis

P175. Rates of colectomy in ulcerative colitis (UC) through time in a Latin Americans unit of inflammatory bowel disease

P175. Rates of colectomy in ulcerative colitis (UC) through time in a Latin Americans unit of inflammatory bowel disease

P563. Subtotal colectomy for ulcerative colitis: distinct short-term and long-term advantages of the laparoscopic approach

P563. Subtotal colectomy for ulcerative colitis: distinct short-term and long-term advantages of the laparoscopic approach

Colectomy Rates for Ulcerative Colitis Differ between Ethnic Groups: Results from a 15-Year Nationwide Cohort Study.

Introduction. Previous epidemiological studies suggest a higher rate of pancolonic disease in South Asians (SA) compared with White Europeans (WE). The aim of the study was to compare colectomy rates for ulcerative colitis (UC) in SA to those of WE. Methods. Patients with UC were identified from a national administrative dataset (Hospital Episode Statistics, HES) between 1997 and 2012 according to ICD-10 diagnosis code K51 for UC. The colectomy rate for each ethnic group was calculated as the proportion of patients who underwent colectomy from the total UC cases for that group. Results. Of 212,430 UC cases, 73,318 (35.3%) were coded for ethnicity. There was no significant difference in the colectomy rate between SA and WE (6.93% versus 6.90%). Indians had a significantly higher colectomy rate than WE (9.8% versus 6.9%, p < 0.001). Indian patients were 21% more likely to require colectomy for UC compared with WE group (OR: 1.21, 95% CI: 1.04–1.42, and p = 0.001). Conclusions. Given the limitations in coding, the colectomy rate in this cohort was higher in Indians compared to WE. A prospectively recruited ethnic cohort study will decipher whether this reflects a more aggressive phenotype or is due to other confounding factors.

Surgery for Ulcerative Colitis Is Associated with a High Rate of Readmissions at 30 Days.

Currently, the predictors of readmission after colectomy specifically for ulcerative colitis (UC) are poorly investigated. We sought to determine the rates and predictors of 30-day readmissions after colectomy for UC. Patients undergoing total proctocolectomy and end ileostomy, abdominal colectomy with end ileostomy, proctocolectomy with ileoanal pouch anastomosis (IPAA) formation and diverting ileostomy, one stage IPAA, or abdominal colectomy with ileorectal anastomosis at a tertiary care center between January 2002 and January 2012 for UC were included. Patients were identified using ICD-9 code 556.x. Each record was manually reviewed. The electronic record system was reviewed for demographic information, medical histories, UC history, medications, and data regarding the admission and discharge. Charts were reviewed for readmissions within 30 days of surgery. Univariate and multivariate analyses were performed using Stata v.13. Two hundred nine patients with UC underwent a colectomy. Forty-three percent had a proctocolectomy with IPAA and diverting ileostomy and 32% had abdominal colectomy with end ileostomy. Seventy-six percent of surgeries were due to failure of medical therapy and 68% of patients were electively admitted for surgery. Thirty-two percent (n = 67/209) of the cohort was unexpectedly readmitted within 30 days. In multivariate model, proctocolectomy with IPAA and diverting ileostomy (odds ratio [OR] = 2.11; 95% CI, 1.06-4.19; P = 0.033) was the only significant predictor of readmission. Hospital length of stay >7 days (OR = 1.82; 95% CI, 0.98-3.41; P = 0.060), presence of limited UC (OR = 2.10; 95% CI, 0.93-4.74; P = 0.074), and steroid before admission (OR = 1.69; 95% CI, 0.90-3.2; P = 0.100) trended toward significance. Surgery for UC is associated with a high rate of readmission. Further prospective studies are necessary to determine the means to reduce these readmissions.

Mortality associated with medical therapy versus elective colectomy in ulcerative colitis: a cohort study.

Ulcerative colitis (UC) can be treated with surgery or medications. Patients often must choose between long-term immunosuppressant therapy or total colectomy. Whether one of these treatment approaches has a mortality benefit is uncertain. To determine whether patients with advanced UC treated with elective colectomy have improved survival compared with those treated with medical therapy. Retrospective matched cohort study. Data from all 50 states for Medicaid beneficiaries (2000 to 2005), Medicare beneficiaries (2006 to 2011), and dual-eligible persons (2000 to 2011). 830 patients with UC pursuing elective colectomy and 7541 matched patients with UC pursuing medical therapy. The primary outcome was time to death. Cox proportional hazards models were used to compare the survival of patients with advanced UC treated with elective colectomy or medical therapy. The models controlled for significant comorbid conditions through matched and adjusted analysis. The mortality rates associated with elective surgery and medical therapy were 34 and 54 deaths per 1000 person-years, respectively. Elective colectomy was associated with improved survival compared with long-term medical therapy (adjusted hazard ratio [HR], 0.67 [95% CI, 0.52 to 0.87]), although this result did not remain statistically significant in all sensitivity analyses. Post hoc analysis by age group showed improved survival with surgery in patients aged 50 years or older with advanced UC (HR, 0.60 [CI, 0.45 to 0.79]; P= 0.032 for age-by-treatment interaction). Retrospective nonrandomized analysis is subject to residual confounding. The source cohort was derived from different databases throughout the study. Sensitivity and secondary analyses had reduced statistical power. Elective colectomy seemed to be associated with improved survival relative to medical therapy among patients aged 50 years or older with advanced UC. National Institutes of Health and Agency for Healthcare Research and Quality.

PTH-063 Different colectomy rates for ulcerative colitis across ethnic groups in england: Abstract PTH-063 Table 1

Introduction Previous epidemiological studies suggest a higher rate of pan-colonic disease in South Asians (SA) compared with Caucasians. There is limited data on disease severity across ethnic groups. Refractory disease and development of dysplasia indicate aggressive disease and are both indications for colectomy. The aim of the study was to compare the risk of colectomy for ulcerative colitis (UC) in SA migrants to Caucasians. Method Patients with UC were identified from a national administrative dataset (Hospital Episode Statistics – HES) between 1997–2012 according to ICD-10 diagnosis code K51 for UC. From the cases coded for ethnicity, colectomy cases were identified according to the Office of Population Censuses and Surveys (OPCS) codes. The colectomy rate for each ethnic group was calculated as the proportion of patients who underwent colectomy from the total UC cases for that group. The median age at time of colectomy was calculated for each ethnic group. Chi-squared testing was used to determine significant differences in colectomy rate and Kruskal-Wallis test to ascertain differences in age at colectomy between ethnic groups. Results Of 212,430 UC cases, 74,988 (35.3%) were coded for ethnicity. Of these cases most were White Europeans (Caucasians) 69,208/74,988 (92.3%). The SA group consisted of: 1,954/74,988 (2.6%) Indian, 832/74,988 (1.1%) Pakistani and 129/74,988 (0.2%) Bangladeshi ([Table 1][1]). Indians had a significantly higher colectomy rate than White Europeans (10.8% vs 7.4%, p < 0.001). In contrast Pakistanis had a similar (7.0%) and Bangladeshis a significantly lower (4.7%) colectomy rate than the White European group. (7.4%, p < 0.001). SAs undergoing colectomy were significantly younger than White Europeans for each ethnic group (median age; Bangladeshis - 29 years, Pakistanis - 37 years and Indians – 41 years, compared with White Europeans – 49 years, p < 0.001). View this table: Abstract PTH-063 Table 1 Colectomy rate in UC patients by ethnicity Conclusion The colectomy rate is higher in Indians compared to White Europeans. Across SA ethnic groups there are differences in colectomy rate. All SA groups required a colectomy for UC at a younger age than White Europeans. These findings suggest a more aggressive phenotype in SAs and should be validated with a prospectively recruited ethnic cohort. This will also allow examination of contributing factors. Disclosure of interest None Declared. [1]: #T1

PTH-232 Retention of the ileocolic sphincter in a modified brooke ileostomy decreases the loss of key electrolytes in ileostomy fluid of patients who have undergone colectomy for ulcerative colitis

Introduction Previous published work has shown that modifying the traditional Brooke ileostomy (MBI) by retaining the ileocolic sphincter (ICS) preserves a functional high pressure zone which may improve the clinical function of the stoma. The effect of this modification (MBI) on ileal fluid biochemistry has not been reported previously by this group. This study reports the results of this modification on the electrolyte concentration in ileal fluid and also its influence on the reabsorption of urinary electrolytes by way of renal compensation. Method Ileostomy fluid specimens were collected from stoma bags in two groups of patients. Group 1 – ileocolic sphincter retained (MBI); controls – patients undergoing formation of a loop ileostomy (10 cm from the ileocolic junction) as part of an operation for rectal cancer. These samples were collected from patients and controls from stoma bags after an overnight fast. Additionally, 24hr urine collections were made from MBI patients and controls to measure the concentration of routine urinary electrolyes and, in addition, urinary magnesium and calcium. In order to compensate for the changes in urinary volume, which can be accounted for by varied water intake and different kidney efficiency, the urine results for each analyte measured were adjusted against the change in creatinine using a standard formula: adjusted concentration = mmol of analyte/mmol of urinary creatinine. Contemporaneously, routine serum electolytes were collected from patients and controls. This study was approved by the regional ethics committee and statistical analysis was performed using the Wilcoxon paired test where appropriate with p Results 13 MBI patients (mean (SD) age - 52.5(17.8)yrs) were compared with 11 controls age −58.4 (10.9) yrs). Routine serum and urinary biochemistry (except sodium) in both groups was the same. Urinary sodium, calcium and magnesium were raised in patients with a modified Brooke Ileostomy (MBI), when compared to controls: urinary sodium, 8.2 ± 4.5 vs. 4.43 ± 2.19 mmols/mmol creatinine, p Conclusion These results suggest that retention of the ICS in an ileostomy (MBI) has beneficial effects on the retention of ileal sodium, calcium and magnesium by virtue of the reduced reabsorption of these electrolytes from the MBI patients’ urine. Further work is required to confirm this initial finding. Disclosure of interest None Declared.