Endoscopic surveillance of the ileoanal pouch following restorative proctocolectomy for familial adenomatous polyposis

Persistence of underlying disease in the residual rectal mucosa and anal transition zone occurs following mucosectomy with either a hand-sewn anastomosis or a double-stapled anastomosis. Furthermore, recent reports have suggested an increased incidence of neoplasia in the pouch body. For this reason, endoscopic surveillance is performed not only as a screening tool to detect significant intraepithelial neoplastic lesions but also with secondary therapeutic intent aimed at reducing the adenoma burden within the ileoanal pouch. Conventional endoscopic assessment of the ileoanal pouch can be challenging. In the future, novel adjunctive endoscopic technologies such as magnification endoscopy and confocal endomicroscopy may improve our diagnostic and therapeutic management of this group.

References

• 1 Church J. Ileoanal pouch neoplasia in familial adenomatous polyposis: an underestimated threat.  Dis Colon Rectum. 2005;  48 1708-1713
• 2 Beveridge I G, Swain D J, Groves C J. et al . Large villous adenomas arising in ileal pouches in familial adenomatous polyposis: report of two cases.  Dis Colon Rectum. 2004;  47 123-126
• 3 Groves C J, Beveridge G, Swain D J. et al . Prevalence and morphology of pouch and ileal adenomas in familial adenomatous polyposis.  Dis Colon Rectum. 2005;  48 816-823
• 4 Church J M. The ileal pouch-anal anastomosis in challenging patients: stretching the limits.  Aust N Z J Surg. 1995;  65 104-106
• 5 Parc Y R, Olschwang S, Desaint G. et al . Familial adenomatous polyposis: prevalence of adenomas in the ileal pouch after restorative proctocolectomy.  Ann Surg. 2001;  233 360-364
• 6 Wu J S, Paul P, McGannon E A, Church J M. APC genotype, polyp number, and surgical options in familial adenomatous polyposis.  Ann Surg. 1998;  227 57-62
• 7 Hurlstone D P, Shorthouse A J, Cross S S. et al . High-magnification chromoscopic pouchoscopy: a novel in vivo technique for surveillance of the anal transition zone and columnar cuff following ileal pouch-anal anastomosis.  Tech Coloproctol. 2004;  8 173-178; discussion 178
• 8 Kiesslich R, Hoffman A, Neurath M F. Colonoscopy, tumors, and inflammatory bowel disease - new diagnostic methods.  Endoscopy. 2006;  38 5-10
• 9 Paris Workshop Participants . The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach and colon.  Gastrointest Endosc. 2002;  58 S3-S43
• 10 Kudo S, Rubio C A, Teixeira C R. et al . Pit pattern in colorectal neoplasia: endoscopic magnifying view.  Endoscopy. 2001;  33 367-373