Histopathology of Colectomy Specimens Predicts Endoscopic Pouch Phenotype in Patients with Ulcerative Colitis.
Histopathology of Colectomy Specimens Predicts Endoscopic Pouch Phenotype in Patients with Ulcerative Colitis.
复制标题
结肠切除标本的组织病理学可预测溃疡性结肠炎患者的内镜储袋表型。
DOI：
10.1007/s10620-022-07405-y
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发表时间：
2022
影响因子：
3.1
通讯作者：
Shogan,Benjamin
中科院分区：
文献类型：
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作者：
Akiyama,Shintaro;Ollech,JacobE;Traboulsi,Cindy;Rai,Victoria;Glick,LauraR;Yi,Yangtian;Runde,Joseph;Olivas,AndreaD;Weber,ChristopherR;Cohen,RussellD;Olortegui,KingaBSkowron;Hurst,RogerD;Umanskiy,Konstantin;Shogan,Benjamin
背景溃疡性结肠炎(UC)回肠袋-肛管吻合术(IPAA)后“膀胱炎”患者的内窥镜表现可能非常不同。目的我们旨在评估大肠切除标本的组织病理学如何预测UC患者的内窥镜下气囊表型。方法我们回顾评估了接受间歇性腹主动脉造口的UC患者的气囊镜检查，并将气囊发现分为7个主要的表型：(1)正常，(2)传入肢体受累，(3)入口受累，(4)弥漫性，(5)气囊体局灶性炎症，(6)袖炎，和(7)气囊有瘘， ≥ 在回肠造口取下6个月后发现气囊。我们评估了结肠切除标本的临床和病理数据，包括深部、局灶性炎症、肉芽肿和回肠末端受累。应用Logistic回归分析确定各表型的影响因素。结果本研究包括382例UC患者的1,203例支气管镜检查。在多变量分析中，深度炎症与膀胱瘘显著相关(优势比3.27；95%可信区间1.65-6.47；P= 0.0007)。75例深部炎症患者中，仅2例(2.7%)经病理确诊为CD。回肠末端受累显著增加传入肢体受累的风险(优势比2.96；95%可信区间1.0 4~8.47；P= 0.0 4)。其他显微镜特征和表型之间没有显著的相关性。结论我们确定了UC患者结肠切除标本的组织学特征，这些特征可以预测后续的肠袋表型。特别是，切除的结肠中的深部炎症与膀胱瘘显著相关，膀胱瘘是一种预后较差的袋型。
BackgroundThe endoscopic appearance in patients with “pouchitis” after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) can be quite heterogenous. Patients with an endoscopic phenotype resembling Crohn’s disease (CD) are at high risk of pouch loss.AimsWe aimed to assess how the histopathology of colectomy specimens predicts endoscopic pouch phenotypes in UC.MethodsWe retrospectively assessed pouchoscopies from patients with UC who underwent IPAA and classified pouch findings into 7 main phenotypes: (1) normal, (2) afferent limb involvement, (3) inlet involvement, (4) diffuse, (5) focal inflammation of the pouch body, (6) cuffitis, and (7) pouch with fistulas noted ≥ 6 months from ileostomy takedown. We assessed the clinical and pathological data including deep, focal inflammation, granulomas, and terminal ileal involvement in the colectomy specimens. Logistic regression analysis was performed to identify contributing factors to each phenotype.ResultsThis study included 1,203 pouchoscopies from 382 patients with UC. On multivariable analysis, deep inflammation was significantly associated with pouch fistulas (Odds ratio 3.27; 95% confidence interval 1.65–6.47;P= 0.0007). Of the 75 patients with deep inflammation, only two patients (2.7%) were diagnosed with CD based on pathology review. Terminal ileal involvement significantly increased the risk of afferent limb involvement (Odds ratio 2.96; 95% confidence interval 1.04–8.47;P= 0.04). There were no significant associations between other microscopic features and phenotypes.ConclusionsWe identify histologic features of colectomy specimens in UC that predict subsequent pouch phenotypes. Particularly, deep inflammation in the resected colon was significantly associated with pouch fistulas, a pouch phenotype with poor prognosis.