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Monday Poster Session

Category: Biliary/Pancreas

P1771 - Natural History of Ileal Pouch Anal Anastomosis in Patients With Primary Sclerosing Cholangitis: A Population-Based Analysis

Monday, October 28, 2024
10:30 AM – 4:00 PM ET
Location: Exhibit Hall E
Has Audio

    Presenting Author(s)

  • Saqr Alsakarneh, MD

    University of Missouri - Kansas City School of Medicine
    Kansas City, MO

Saqr Alsakarneh, MD1, Abdulla Massad, MD2, Aakash Desai, MD3, Edward Barnes, MD, MPH, FACG4, Gursimran S. Kochhar, MD5, Fadi F. Francis, MD6, Francis A. Farraye, MD, MSc7, Jana G. Hashash, MD, MSc7
1University of Missouri - Kansas City School of Medicine, Kansas City, MO; 2University of Texas Medical Branch, Galveston, TX; 3Mayo Clinic, Pittsburgh, PA; 4University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; 5Allegheny General Hospital, Pittsburgh, PA; 6University of Pittsburgh, Pittsburgh, PA; 7Mayo Clinic, Jacksonville, FL

Introduction: Patients with ulcerative colitis (UC) who undergo ileal pouch-anal anastomosis (IPAA) are at high risk of complications. However, there are limited population-level data on the long-term complications of IPAA in patients with primary sclerosing cholangitis (PSC). We aimed to evaluate the natural history of UC/IPAA in patients with PSC compared to those with UC and IPAA with no history of PSC.

Methods: We conducted a retrospective cohort study using TriNetX database between 2010-2023 to identify patients who were ≥18 years of age with PSC and who underwent total proctocolectomy and IPAA for UC (PSC-IBD cohort). Patients in the PSC-IBD cohort were matched with patients without a history of PSC who had UC and IPAA (non-PSC UC cohort) by using 1:1 propensity score matching. The primary outcome of the study was the development of acute pouchitis within 1-, 3-, 5-, and 10 years from the time of pouch creation. The secondary outcome was to evaluate the need for advanced therapies (anti-tumor necrosis factor agents, vedolizumab, ustekinumab, and tofacitinib).

Results: A total of 179 patients with history of PSC and UC/IPAA were identified (mean age at IPAA: 38.6±14.2 years, female 32%, White 76%). Of these patients, 23% used infliximab and/or adalimumab before IPAA. The incidence of pouchitis in the PSC-IBD cohort was 56%, 69.4%, 78.9% and 88.4% at 1-, 3-, 5-, and 10-year, respectively. Compared to patients without history of PSC (non-PSC UC cohort), patients with PSC were at higher risk of pouchitis at 5- and 10-year (5-year: aOR: 2.53; [95% CI: 1.39 - 4.61], 10-year: aOR: 7.26; [95% CI: 12.4 - 21.96]). However, at 1- and 3-year intervals, there were no differences in risk of pouchitis between the two cohorts. The two groups had no statistically significant difference in advanced therapy use.

Discussion: Our results demonstrate that patients with PSC who undergo IPAA have a higher risk of pouchitis compared to those without a history of PSC, with rates increasing significantly over time. These findings indicate a substantial long-term management burden for those with a history of PSC and undergoing IPAA for UC.

Figure: Table 2: Incidence of pouchitis in patients with ulcerative colitis with and without primary sclerosing cholangitis.

Abbreviations: aOR: Adjusted odds ratio; PSC: primary sclerosing cholangitis; IPAA: ileal pouch-anal anastomosis


Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.


Disclosures:
Saqr Alsakarneh indicated no relevant financial relationships.
Abdulla Massad indicated no relevant financial relationships.
Aakash Desai indicated no relevant financial relationships.
Edward Barnes: AbbVie, Inc. – Consultant. Boomerang – Consultant. Bristol-Meyers Squibb – Consultant. Direct Biologics – Consultant. Eli Lilly and Company – Advisor or Review Panel Member. Pfizer – Consultant. Target RWE – Consultant.
Gursimran Kochhar: Boston Scientific Endoscopy – Consultant. DigbI – Stock Options. Eli Lilli – Advisory Committee/Board Member, Speakers Bureau. Olympus Endoscopy – Consultant. Pentax Endoscopy – Consultant. Takeda – Consultant.
Fadi Francis indicated no relevant financial relationships.
Francis Farraye: AbbVie – Consultant. Avalo Therapeutics – Consultant. Bausch – Advisor or Review Panel Member. BMS – Consultant. Braintree Labs – Consultant. DSMB for Lilly. – Sits on. Fresenius Kabi – Consultant. GI Reviewers and IBD Educational Group – independent contractor. GSK, Iterative Health, Janssen, Pfizer, Pharmacosmos, Sandoz Immunology, Sebela and Viatris – Consultant.
Jana Hashash: Bristol Myers Squibb – Consultant.


Saqr Alsakarneh, MD1, Abdulla Massad, MD2, Aakash Desai, MD3, Edward Barnes, MD, MPH, FACG4, Gursimran S. Kochhar, MD5, Fadi F. Francis, MD6, Francis A. Farraye, MD, MSc7, Jana G. Hashash, MD, MSc7. P1771 - Natural History of Ileal Pouch Anal Anastomosis in Patients With Primary Sclerosing Cholangitis: A Population-Based Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.