Systematic Review and Meta-Analysis of Outcomes after Ileal Pouch-Anal Anastomosis in Primary Sclerosing Cholangitis-Ulcerative Colitis.

BACKGROUND: The optimal restorative surgical management of patients with concomitant diagnoses of primary sclerosing cholangitis and ulcerative colitis (PSC-UC) who require colectomy is controversial, given that patients may have an increased risk for pouchitis after ileal pouch-anal anastomosis (IPAA). We aimed to compare rates of pouchitis and pouch failure among patients with and without PSC by performing a systematic review and meta-analysis.

METHODS: A systematic search performed through August 18, 2020 identified 12 studies that compared the rates of pouchitis (n=11) and/or pouch failure (n=6) among patients with PSC-UC and UC alone. We then performed a meta-analysis using random effects modeling to estimate the odds of developing any episodes of pouchitis or pouch failure.

RESULTS: A total of 4,108 patients underwent an ileal pouch-anal anastomosis after proctocolectomy for UC. Of these, 3,799 (92%) were performed for UC alone while 309 (8%) were performed for PSC-UC. In a meta-analysis of 11 studies, patients with PSC-UC compared to UC alone were significantly more likely to develop any pouchitis (63% vs. 30%, OR 4.21, 95% CI 2.86 - 6.18), chronic pouchitis (47% vs. 15%, OR 6.37, 95% CI 3.41 - 11.9) and pouch failure (10% vs. 7%, OR 1.85, 95% CI 1.08 - 3.17).

CONCLUSIONS: Patients with PSC-UC were more likely to experience pouchitis and pouch failure compared to UC alone. The risks of inflammatory complications after IPAA must be weighed against the potential complications with other surgical procedures, and future studies comparing outcomes among these procedures may inform decision making in this population.