Abstracts
2001 Digestive Disease Week

# 2405 In Search of Ileal Mucosal Dysplasia:
A Prospective Study of 138 Pelvic Pouch Patients Recalled One or More Years Following Restorative Proctocolectomy.

Naris Nilubol, Joel J. Bauer, Stephen R. Gorfine, Ellen Scherl, Arthur A Kornbluth, Simon Lichtiger, Peter H. Rubin, James George, Mark L. Chapman, Noam Harpaz, Carmelita Tejero, Daniel H. Present, New York, NY

PURPOSE: This study was designed to explore ileal mucosal changes following restorative proctocolectomy (RPC) with particular attention to the incidence of mucosal dysplasia.

METHODS: Patients who had undergone restorative proctocolectomy, including complete mucosection, one or more years prior to enrollment were recruited to participate. Informed consent was obtained from all participants under IRB supervision. Enrolled patients completed a standard questionaire and underwent pouchoscopy and random mucosal biopsies. From 1 to 3 biopsies were taken from 6 specific pouch locations (inflow, blind limb, upper, middle, lower, and pouch-anal anastomosis). Two independent pathologists interpreted all specimens, and the senior pathologist reviewed all specimens.

RESULTS: Five hundred ninety-six patients from one surgical practice met enrollment criteria. Of these, 326 patients were located and contacted. One hundred thirty-eight patients agreed to fully participate in the experimental protocol. Of these 138 patients, 118 had had ulcerative colitis, 10 had had polyposis, 8 had had indeterminent colitis and 2 had had Crohn's colitis. The mean time from surgery to biopsy was 5.9 years (range 1.1 to 15.5 years). Histological evidence of mucosal inflammation was common. None of the patients had villous atrophy. One patient was found to have indefinite dysplasia at two separate locations within the pouch. This patient had no identifiable risk factors for the development of pouch dysplasia.

CONCLUSION: Mucosal inflammatory changes are common following RPC. The risk of pouch dysplasia appears to be quite small. Preoperative presence of colonic dysplasia or carcinoma did not seem to increase the risk of pouch dysplasia.