crohn’s colitis patients should never be offered an ileoanal pouch asher kornbluth, md clinical...
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Crohn’s Colitis Patients Should Never Be Offered an Ileoanal Pouch
Asher Kornbluth, MD
Clinical Professor of Medicine
The Henry D. Janowitz Division of
Gastroenterology
The Icahn School of Medicine at Mount Sinai
Last Year’s Debate:22 year old, Severe UC Failing 5
Days IV SteroidsTheir Position:
Infliximab 5 mg/kg and subtotal colectomy if no improvement in 5
days
My Prior Debates:22 year old, Severe UC Failing 5 Days
IV Steroids
• Bedside Commode
• Start Kosher Diet
Problems with Pouches in Patients with Crohn’s disease
• The problem of symptoms
• The problem of local complications
• The problem of major complications
• The problem of pouch failure and excision
Problems with Pouches in Patients with Crohn’s disease
• The problem of symptoms
• The problem of local complications
• The problem of major complications
• The problem of pouch failure and excision
Problems with Pouches in Patients with Crohn’s disease
• The problem of symptoms
• The problem of local complications
• The problem of major complications
• The problem of pouch failure and excision
Perianal complications in patients with pre-op Crohn’s disease
Richard et al, Dis Colon Rectum, 1997
Fistula – Free Survival Analysis:IC-UC vs. IC-Crohn’s disease/Crohn’s
disease
Tekkis PP, et al. Colorectal Disease 2005; 7: 218
Problems with Pouches in Patients with Crohn’s disease
• The problem of symptoms
• The problem of local complications
• The problem of major complications
• The problem of pouch failure and excision
Meta Analysis of Crohn’s disease pouch outcomes: Highest quality
series
Reese GE, et al. Dis Colon Rectum 2007; 50:239
Meta Analysis of Crohn’s disease pouch outcomes: More Recent
Series
Reese GE, et al. Dis Colon Rectum 2007; 50:239
Meta Analysis of Crohn’s disease pouch outcomes: Most experienced
surgeons
Reese GE, et al. Dis Colon Rectum 2007; 50:239
Problems with Pouches in Patients with Crohn’s disease
• The problem of symptoms
• The problem of local complications
• The problem of major complications
• The problem of pouch failure and excision
Pouch Survival: IC-UC vs. IC-Crohn’s disease, or CD
Tekkis PP, et al. Colorectal Disease 2005; 7: 218
Risk factors for pouch failure: The Cleveland Clinic experience
Fazio VW, et al. Ann Surgery 2003; 4:238
Planned Ileoanal Pouches for Crohn’s disease:Conclusions
• Pre-operative diagnosis of Crohn’s disease increases postoperative complications– Pouch fistula– Pelvic sepsis– Pouch failure!
• Multivariate analysis controlling for other variables likewise predict pre-op Crohn’s disease as predictor of increased pouch failure rate
• Increased incidence of poor outcomes in Crohn’s disease pouches are more common even in the most experienced centers