PREOPERATIVE TERMINAL ILEAL AND COLONIC RESECTION HISTOPATHOLOGY PREDICTS RISK OF POUCHITIS IN PATIENTS AFTER ILEOANAL PULL-THROUGH PROCEDURE

Objective This study seeks to compare the histopathology of preoperati ve terminal ileal and colonic resection specimens with pouch biopsies after the ileoanal pull-through (IAPT) procedure. Summary Background D ata Pouchitis is the most frequent complication of transanal continent reservoirs in patients after IAPT. Methods The authors conducted 751 consecutive pouch biopsies on 73 patients with inflammatory bower dise ase or familial adenomatous polyposis who underwent IAPT by a single s urgeon over a 10-year period. In this preliminary report, a pathologis t, in blinded fashion, has graded 468 of the IAPT pouch biopsies and 6 7 of the patients' preoperative terminal ileal and colonic resection h istopathology to date. Colonic histopathol ogy was graded by the exten t and severity of disease, terminal ileal and pouch histopathology by active inflammation, chronic inflammation, lymphocyte aggregates, intr aepithelial lymphocytes, eosinophils, and villous blunting. Results Ex tent of colonic disease (gross and microscopic) was a significant pred ictor of active inflammation in subsequent IAPT pouch biopsy specimens . Also, the gross extent of colonic disease exhibited a significant li near association with pouch inflammation. However, the severity of col onic disease was not significantly predictive of active inflammation i n subsequent IAPT pouch biopsies. Terminal ileal active and chronic in flammation were significant predictors of subsequent IAPT pouch inflam mation. Although lymphocyte aggregates and intraepithelial lymphocytes were not predictive, terminal ileum eosinophils and villous blunting were significant predictors of active inflammation in subsequent IAPT pouch biopsy specimens. Conclusions Preoperative terminal ileal and co lonic histopathology predicts active inflammation of pouches after IAP T, Patients who are preoperatively assessed to have extensive disease of the colon, ileal disease (''backwash ileitis''), or both appear to be at greater risk for the development of pouchitis after IAPT,