Neoplasia in the ileoanal pouch following colectomy in patients with ulcerative colitis and primary sclerosing cholangitis

Mohamad H. Imam, John E. Eaton, Jason S. Puckett, Edward V. Loftus, Kellie L. Mathis, Andrea A. Gossard, Jayant A. Talwalkar, Keith Lindor

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19 Scopus citations


Background & Aims: Primary sclerosing cholangitis (PSC) is typically associated with inflammatory bowel disease (IBD), particularly ulcerative colitis (UC). PSC-IBD patients are at an increased risk for colorectal neoplasia. The ileal pouch-anal anastomosis (IPAA) is a treatment option for patients with medically refractory UC or neoplasia. However, little is known about the development of pouch neoplasia in PSC-UC patients following an IPAA. We aim to describe the incidence of pouch neoplasia in PSC-UC patients after an IPAA. Methods: We conducted a retrospective chart review of patients with a confirmed diagnosis of PSC and IBD who underwent colectomy with IPAA followed by pouch surveillance between 1995 and 2012. Results: Sixty-five patients were included in the cohort and were followed up from the time of colectomy/IPAA for a median of 6. years. The most common indications for surgery were low-grade dysplasia (LGD) and refractory colitis. Only 3 patients developed evidence of neoplasia (LGD n. =. 1, high-grade dysplasia n. =. 1, adenocarcinoma n. =. 1). The cumulative 5-year incidence of pouch neoplasia was 5.6% (95% confidence intervals [CI], 1.8%-16.1%). Conclusion: Based on our short-term follow-up, surveying the pouch frequently appears to be an unnecessary practice in PSC-IBD patients. Longer follow-up will be needed to develop an optimal surveillance strategy for the development of dysplasia and cancer in such patients.

Original languageEnglish (US)
Pages (from-to)1294-1299
Number of pages6
JournalJournal of Crohn's and Colitis
Issue number10
StatePublished - Oct 1 2014


  • Autoimmune liver disease
  • Colorectal cancer
  • Inflammatory bowel disease

ASJC Scopus subject areas

  • Gastroenterology


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