Ileal pouch-anal anastomosis in patients with indeterminate colitis - Long-term results

PURPOSE: Patients with chronic ulcerative colitis who undergo proctocolecto my and are found intraoperatively to harbor histologic signs suggesting Cro hn's disease have indeterminate colitis; nonetheless, ileal pouch-anal anas tomosis is usually performed. The aim of this study was to determine the lo ng-term outcome of ileal pouch-anal anastomosis in patients with indetermin ate colitis compared with a cohort of patients with chronic ulcerative coli tis. METHOD: Review of an ileal pouch-anal anastomosis registry identified 1,437 patients with chronic ulcerative colitis and 82 patients with indeter minate colitis who underwent an ileal pouch-anal anastomosis between 1981 a nd 1995. The median follow-up was 83 (range, 1-192) months. Demographic dat a and functional outcomes were compared by chi-squared and Wilcoxon's rank- sum tests. Probabilities of complications and pouch failure were analyzed u sing Kaplan-Meier and log-rank techniques. Finally, Bonferroni adjustments were used for multiple comparisons. RESULTS: Patients with indeterminate co litis and chronic ulcerative colitis were comparable in terms of gender and length of follow-up. The mean age of the chronic ulcerative colitis group was higher (34 vs. 31; P < 0.01). At ten pears patients with indeterminate colitis had significantly more episodes of pelvic sepsis (17 percent indete rminate colitis vs. 7 percent chronic ulcerative colitis; P < 0.001), pouch fistula (31 vs. 9 percent; P < 0.001), and pouch failure (27 vs. 11 percen t; P < 0.001). Importantly, during follow-up fully 15 percent of patients w ith indeterminate colitis, but only 2 percent of patients with chronic ulce rative colitis, had their original diagnosis changed to Crohn's disease (P < 0.001). When the outcomes of these patients newly diagnosed with Crohn's disease were considered separately, the rate of complications for the remai ning patients with indeterminate colitis was identical to that of patients with chronic ulcerative colitis. Functional outcomes were comparable among all three groups. CONCLUSION: After ileal pouch-anal anastomosis patients w ith indeterminate colitis who did not develop Crohn's disease subsequently experienced long-term outcomes nearly identical to patients with chronic ul cerative colitis. Crohn's disease, whether it develops after surgery for ch ronic ulcerative colitis or indeterminate colitis, is associated with poor long-term outcomes.