QS205 - Patients with Primary Sclerosing Cholangitis and Ulcerative Colitis Have High Rates of Pouchitis but Low Rates of Pouch Failure

Purpose/Background: Primary sclerosing cholangitis (PSC) is a progressive biliary disease that can affect patients with ulcerative colitis (UC). Colectomy rates remain high in patients with UC and this is especially true in patients with concurrent PSC because of the increased risk of colorectal malignancy. Ileal pouch anal anastomosis (IPAA) offers a reconstructive option for patients following colectomy. However, previous studies have demonstrated high rates of pouchitis in patients with PSC. This study investigated the outcomes of IPAA surgery in patients with PSC at a high-volume inflammatory bowel disease centre.

Methods/Interventions: All IPAA procedures performed at our institution between 1982 and May 2022 were identified from a prospectively maintained database. Inclusion criteria were confirmed diagnosis of PSC and IPAA surgery performed over the age of 18. Patients with Koch pouches were excluded. Paper and computer records were reviewed for data collection. Appropriate ethical approval was obtained. Primary outcome was pouch failure. Secondary outcomes were the clinical, endoscopic and histological diagnosis of pouchitis and requirement for extended or recurrent antibiotic therapy or biological treatment.

Results/Outcomes: 45 patients were identified with confirmed diagnosis of PSC who underwent IPAA surgery. Median follow-up time was 182 months. 14 (31%) of patients had required at least one liver transplant, 8 (18%) had liver transplant prior to IPAA surgery. Pouch failure occurred in three (7%) patients (two pouch excisions and one defunctioned pouch). Time to pouch failure was 104, 147 and 230 months. 25 (56%) patients reported symptoms of pouchitis during their follow-up. 21 (47%) had endoscopic evidence of pouchitis and 12 (27%) had biopsy proven pouchitis. 18 (40%) of patients required recurrent or extended antibiotic therapy for pouchitis. One (2%) patient had infliximab for the treatment of pouchitis.

Conclusion/Discussion: This study corroborates previous studies that have demonstrated high rates of pouchitis in patients with PSC who have IPAA reconstruction. However, pouch failure rates were low. Limitations include the observational nature of the study and the risk of attrition bias as a tertiary referral centre.