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Crohn’s Colitis Patients Should Never Be Offered an Ileoanal Pouch

Crohn’s Colitis Patients Should Never Be Offered an Ileoanal Pouch. Asher Kornbluth, MD Clinical Professor of Medicine The Henry D. Janowitz Division of Gastroenterology The Icahn School of Medicine at Mount Sinai. Last Year’s Debate: 22 year old, Severe UC Failing 5 Days IV Steroids.

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Crohn’s Colitis Patients Should Never Be Offered an Ileoanal Pouch

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  1. Crohn’s Colitis Patients Should Never Be Offered an Ileoanal Pouch Asher Kornbluth, MD Clinical Professor of Medicine The Henry D. Janowitz Division of Gastroenterology The Icahn School of Medicine at Mount Sinai

  2. Last Year’s Debate:22 year old, Severe UC Failing 5 Days IV Steroids Their Position: Infliximab 5 mg/kg and subtotal colectomy if no improvement in 5 days

  3. My Prior Debates:22 year old, Severe UC Failing 5 Days IV Steroids • Bedside Commode • Start Kosher Diet

  4. To Make

  5. It Fair

  6. For Our

  7. Surgeon Friends

  8. I’ll Try

  9. To Speak

  10. Slowly

  11. And with only

  12. 1 or

  13. Maybe 2

  14. Syllables

  15. Per

  16. Word

  17. Problems with Pouches in Patients with Crohn’s disease • The problem of symptoms • The problem of local complications • The problem of major complications • The problem of pouch failure and excision

  18. Problems with Pouches in Patients with Crohn’s disease • The problem of symptoms • The problem of local complications • The problem of major complications • The problem of pouch failure and excision

  19. Increased symptoms in Crohn’s disease pouches Shen B, Am J Gastro 2005; 100: 93-104

  20. Increased symptoms in patients with pre-op perineal disease Richard et al, Dis Colon Rectum, 1997

  21. Problems with Pouches in Patients with Crohn’s disease • The problem of symptoms • The problem of local complications • The problem of major complications • The problem of pouch failure and excision

  22. Pouch Fistula in Crohn’s disease Shen , et al CGH 2008

  23. Perianal complications in patients with pre-op Crohn’s disease Richard et al, Dis Colon Rectum, 1997

  24. Fistula – Free Survival Analysis:IC-UC vs. IC-Crohn’s disease/Crohn’s disease Tekkis PP, et al. Colorectal Disease 2005; 7: 218

  25. Problems with Pouches in Patients with Crohn’s disease • The problem of symptoms • The problem of local complications • The problem of major complications • The problem of pouch failure and excision

  26. Meta Analysis:Major Complications of the Pouch in Patients with Crohn’s disease

  27. Meta Analysis of Crohn’s disease pouch outcomes: Highest quality series Reese GE, et al. Dis Colon Rectum 2007; 50:239

  28. Meta Analysis of Crohn’s disease pouch outcomes: More Recent Series Reese GE, et al. Dis Colon Rectum 2007; 50:239

  29. Meta Analysis of Crohn’s disease pouch outcomes: Most experienced surgeons Reese GE, et al. Dis Colon Rectum 2007; 50:239

  30. Problems with Pouches in Patients with Crohn’s disease • The problem of symptoms • The problem of local complications • The problem of major complications • The problem of pouch failure and excision

  31. Pouch Failure Rate: Crohn’s disease vs. UC Brown CR, et al. Dis Colon Rectum 2005; 48: 1542

  32. Pouch Survival: IC-UC vs. IC-Crohn’s disease, or CD Tekkis PP, et al. Colorectal Disease 2005; 7: 218

  33. Risk factors for pouch failure: The Cleveland Clinic experience Fazio VW, et al. Ann Surgery 2003; 4:238

  34. Planned Ileoanal Pouches for Crohn’s disease:Conclusions • Pre-operative diagnosis of Crohn’s disease increases postoperative complications • Pouch fistula • Pelvic sepsis • Pouch failure! • Multivariate analysis controlling for other variables likewise predict pre-op Crohn’s disease as predictor of increased pouch failure rate • Increased incidence of poor outcomes in Crohn’s disease pouches are more common even in the most experienced centers

  35. Thank You For Your Attention

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