Colectomy for patients with ulcerative colitis and primary sclerosing cholangitis - what next?

M Block; K K Jørgensen; T Oresland; E Lindholm; K Grzyb; M Cvancarova; M H Vatn; K M Boberg; L Börjesson

doi:10.1016/j.crohns.2013.10.008

Colectomy for patients with ulcerative colitis and primary sclerosing cholangitis - what next?

J Crohns Colitis. 2014 May;8(5):421-30. doi: 10.1016/j.crohns.2013.10.008. Epub 2013 Nov 12.

Authors

M Block¹, K K Jørgensen², T Oresland³, E Lindholm⁴, K Grzyb⁵, M Cvancarova⁶, M H Vatn², K M Boberg⁷, L Börjesson⁴

Affiliations

¹ Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden. Electronic address: mattias.block@vgregion.se.
² Section for Gastroenterology, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Norwegian PSC Research Centre, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
³ Section for Gastroenterology, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; EpiGen Institute, Akershus University Hospital, Lorenskog, Norway.
⁴ Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
⁵ Division of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
⁶ Department of Biostatistics, University of Oslo, Oslo, Norway.
⁷ Section for Gastroenterology, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Norwegian PSC Research Centre, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.

PMID: 24239402
DOI: 10.1016/j.crohns.2013.10.008

Abstract

Background and aims: Primary sclerosing cholangitis (PSC) occurs in 2%-8% of patients who suffer from ulcerative colitis (UC). For patients who require colectomy, ileal pouch-anal anastomosis (IPAA) or ileorectal anastomosis (IRA) is employed to preserve continence.We evaluated the outcomes after IPAA and IRA for patients with UC-PSC, using patients with UC but without PSC as controls (UC-only group).

Patients: In a case-control study conducted at Sahlgrenska University Hospital, Sweden, patients with UC-PSC (N=48; 31 IPAA and 17 IRA) were compared to patients with UC only (N=113; 62 IPAA and 51 IRA). Functional outcomes (Öresland score), pouchitis, surgical complications, and failure were evaluated.

Results: For patients with IPAA, the median Öresland scores were similar for the two groups: 5 (range, 0-13) for the UC-PSC group and 5 for the UC-only group (range, 0-12; p>0.05). However, the IRA scores were significantly different at 7 (range, 2-11) and 3 (range, 0-11) for the respective groups (p=0.005). Pouchitis was more frequent in patients with UC-PSC. Complication rates did not differ. For patients with IPAA, the failure rate was 16% for those in the UC-PSC group versus 6% for those in the UC-only group (p>0.05); the corresponding results for IRA were 53% versus 22% (p=0.03).

Conclusions: For cases of IPAA, pouchitis seems to be more common in patients with UC-PSC. However, the functional outcomes and failure rates are unaffected by concurrent PSC. For patients with UC-PSC, functional outcome is poor and the failure rate is high after IRA.

Keywords: Functional outcome; Ileal pouch-anal anastomosis; Ileorectal anastomosis; Pouchitis; Primary sclerosing cholangitis; Ulcerative colitis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Case-Control Studies
Cholangitis, Sclerosing / complications
Cholangitis, Sclerosing / surgery*
Colectomy* / methods
Colitis, Ulcerative / complications
Colitis, Ulcerative / surgery*
Colonic Pouches*
Female
Humans
Male
Middle Aged
Quality of Life
Risk Factors
Treatment Outcome