Nallapaneni P, Picoraro JA. Diagnosis and Treatment of Pouch Disorders in Children: A Systematic Review.
Dis Colon Rectum 2024;
67:S115-S124. [PMID:
38422401 DOI:
10.1097/dcr.0000000000003317]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND
Restorative proctocolectomy and IPAA have become the surgical procedure of choice in pediatric patients with medically refractory colitis or familial adenomatous polyposis.
OBJECTIVE
This systematic review aims to assess the diagnosis and treatment of pouch disorders in pediatric patients who undergo IPAA.
DATA SOURCES
A literature search was performed using MEDLINE, Google Scholar, and Embase for all publications describing outcomes of pediatric IPAA.
STUDY SELECTION
Studies between January 1, 2000, and September 7, 2022, published in English were included. Studies were excluded on the basis of title, abstract, and full-length review.
INTERVENTIONS
IPAA.
MAIN OUTCOME MEASURES
Pouch disorders described include anastomotic leaks, pouch strictures, pouch failure, pouchitis, cuffitis, and de novo Crohn's disease of the pouch.
RESULTS
Thirty-three studies were included in this review, all of which were retrospective in nature. The outcomes of 2643 pediatric patients were included in the 33 studies.
LIMITATIONS
Management is largely informed by clinical practices in adult patients with scant data on treatment efficacy in children.
CONCLUSIONS
The reported incidence of disorders of the pouch in children varies widely and is likely attributable to differences in definitions and follow-up periods across studies. Pouchitis was the most frequently described outcome. The overall rate of pouch failure in children is relatively low, with de novo Crohn's disease of the pouch being the most significant risk factor. Multicenter prospective studies are needed in the pediatric population to accurately identify risk factors, standardize the assessment of pouch complications, and determine effective treatment strategies. See video from the symposium .
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