Priya Kathuria, MD1, Charlotte Larson, MD1, Dustin Romain, MD1, Daniel Aintabi, MD, MSc2, Nicholas Tedesco, BS1, Shirley Cohen-Mekelburg, MD, MS3, Peter Higgins, MD1, Jeffrey A. Berinstein, MD1 1University of Michigan, Ann Arbor, MI; 2Trinity Health Ann Arbor Hospital, Ann Arbor, MI; 3Michigan Medicine, Ann Arbor, MI
Introduction: Ulcerative colitis (UC) patients undergoing total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) can develop pouchitis and Crohn’s-like disease of the pouch requiring re-initiation of anti-inflammatory therapy. Several studies have demonstrated an association between pre-colectomy inflammatory burden and pouchitis development. This study aimed to identify risk factors for development of these complications.
Methods: We performed a retrospective cohort study of patients with an episode of ASUC who underwent TPC. Baseline characteristics and clinical course were reported as numbers and proportions or means and standard deviations for categorical and continuous variables, respectively. Outcomes of interest included intraoperative or postoperative complications and development of pouchitis or Crohn’s-like disease of the pouch. Intraoperative complications were defined as a vascular injury, bowel injury, or injury to other organs or structures. Postoperative complications were defined as an anastomotic leak, enteric fistula, intra-abdominal abscess, pelvic abscess, surgical site infection, other infection, or ileus. Crohn’s-like disease of the pouch was defined as pouch stenosis, pouch fistula, or re-initiation of corticosteroids or targeted therapy.
Results: Of the 100 included patients, 44 (44%) had a permanent ileostomy and 56 (56%) had an IPAA created. 13 (13%) patients experienced intraoperative complications and 30 (30%) patients experienced postoperative complications. Of the 56 patients who underwent IPAA creation, 18 (32%) developed Crohn’s-like disease of the pouch and 28 (48%) had an episode of pouchitis requiring antibiotics over a mean follow-up time of 39.1 ± 31.5 months. Predictors of intraoperative and postoperative complications included admission C-reactive protein [Odds ratio (OR) 1.09, 95% CI 1.02-1.18, p= 0.014], colonic dilation > 5.5cm (OR 17.5, 95% CI 2.95 to 336, p< 0.001). Infliximab exposure prior to admission for ASUC was associated with a reduced risk of intraoperative and postoperative complications (OR 0.30, 95% CI 0.09 to 0.87, p=0.027). Tofacitinib exposure was associated with a reduced risk of pouchitis (OR 0.22, 95% CI 0.04 to 0.82, p=0.024). No clear predictors of Crohn’s-like disease of the pouch were identified.
Discussion: These results suggest that patients with ASUC at time of colectomy experience frequent intraoperative and postoperative complications and are at higher risk of developing pouchitis and Crohn’s-like disease of the pouch.
Disclosures:
Priya Kathuria indicated no relevant financial relationships.
Charlotte Larson indicated no relevant financial relationships.
Dustin Romain indicated no relevant financial relationships.
Daniel Aintabi indicated no relevant financial relationships.
Nicholas Tedesco indicated no relevant financial relationships.
Shirley Cohen-Mekelburg indicated no relevant financial relationships.
Peter Higgins: AbbVie – Grant/Research Support. Connectome Coordination Facility – Grant/Research Support. GI Health Foundation – Consultant. Imedex – Consultant. Lilly – Consultant. National Institute of Health and Takeda – Grant/Research Support. Pfizer – Consultant. Takeda – Consultant. Vindico Medical Education – Consultant.
Jeffrey Berinstein indicated no relevant financial relationships.
Priya Kathuria, MD1, Charlotte Larson, MD1, Dustin Romain, MD1, Daniel Aintabi, MD, MSc2, Nicholas Tedesco, BS1, Shirley Cohen-Mekelburg, MD, MS3, Peter Higgins, MD1, Jeffrey A. Berinstein, MD1. P0870 - Surgical Outcomes Following an Episode of Acute Severe Ulcerative Colitis: A Single Center Cohort Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
