Taha Qazi, MD: Cuffitis After Pouch Creation and Stricture, Fistula Formation

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Qazi discusses implications from a recent study exploring the impact of post-IPAA cuffitis on long-term pouch outcomes and the risk of developing strictures and fistulas.

Although recent advances in ulcerative colitis therapies have helped decrease the need for colectomy in this patient population, patients who do not respond to medical management may still require surgical intervention.

Often, this includes colectomy followed by the creation of an ileal pouch-anal anastomosis (IPAA), which is frequently linked to pouchitis and cuffitis. Rectal cuff inflammation in particular rectal cuff inflammation has been linked to an increased risk of pouch failure, including pouch explant, pouch re-do, or diversion ileostomy.

The sixth issue of Qazi Corner, a collaborative quarterly newsletter on gastroenterology research, news, and trends between HCPLive and editor-in-chief Taha Qazi, MD, spotlights the impact of cuffitis on long-term outcomes following pouch creation with a retrospective cohort study of adult patients with inflammatory bowel disease (IBD) who underwent IPAA.

“How does cuffitis cause these things? We don't know, but we do know that patients who have cuffitis have overall poor pouch health in general and have higher rates of pouch incision, ileostomy creation, and such,” Qazi, a gastroenterologist with the Cleveland Clinic, explained to HCPLive.

Among a cohort of 402 patients, including 182 in the endoscopic cuff inflammation cohort and 220 in the control cohort, 41 patients developed non-anastomotic strictures and 25 patients developed fistulas during the follow-up period. Univariable analysis showed the development of non-anastomotic strictures and fistulas were both more frequent in the cohort with cuff inflammation (P = .001 and P = .032, respectively), a finding confirmed in further multivariable logistic regression models.

“There was a higher rate of structure formation and these patients not only structures at the cuff but also at other areas in the pouch. There was a higher rates of fistula formation in these patients as well,” Qazi said.

Investigators noted based on these results, endoscopic inflammation of the rectal cuff appears to be associated with structural pathologies of the pouch, potentially contributing to an increased risk of pouch failure and thus requiring additional monitoring to limit the risk of long-term complications.