Aneuploidy and columnar cuff surveillance after stapled ileal pouch-anal anastomosis in ulcerative colitis

PURPOSE: A stapled pouch-anal anastomosis without mucosectomy is widely use d in restorative proctocolectomy. Uncertainty exists about the longer-term outcome of retaining a columnar cuff of epithelium in the anal canal and ab out the need for surveillance of the columnar cuff The aim of this article was to assess the ability to obtain biopsies of the columnar cuff, to asses s the risk of dysplasia, and to search for the presence of aneuploidy as an early of marker of dysplasia in nondysplastic epithelium. METHOD: A total of 457 biopsy specimens were taken during 203 examinations of 113 patients. All biopsy specimens were stained with hematoxylin and eosin and examined by microscopy. One hundred thirty-two of these biopsy specimens from 67 pat ients were frozen and analyzed by now cytometry for aneuploidy. RESULTS: Me an follow-up after pouch formation was 2.5 years, and the time after diagno sis of ulcerative colitis was 10.1 years. Successful columnar cuff biopsies were done on 93 percent of patients. There was no dysplasia. Two biopsy sp ecimens from one patient had aneuploidy. CONCLUSION: To date, neoplastic ch ange in the columnar cuff is rare. A selective policy of surveillance biops ies is recommended that includes patients greater than ten years after the diagnosis of ulcerative colitis and patients with dysplasia or cancer in th eir proctocolectomy specimen, but long-term follow-up data are needed.