Aim: This study aims at identifying the risk factors for the development of pre-cancerous pouch and/or cuff adenomas post ileal pouch anal anastomosis (IPAA) in familial adenomatous polyposis patients. Method: We retrospectively studied 59 patients operated at a single medical center during a 26-year period. Data on the timing and location of adenoma recurrence were recorded and possible correlations with patients' gender, age, presence of desmoid tumor, duodenal adenomas, type of anastomosis and number of operation stages were analyzed. Results: Thirty-five (59%) patients had at least one adenoma in either the cuff or the pouch, including 20 with isolated cuff adenomas, 4 with isolated pouch adenomas and 11 patients with adenomas in both the pouch and cuff. There was no significant correlation between gender, age at surgery, type of anastomosis, number of operative stages and the development of pouch or cuff adenomas. Desmoid tumor and pouch adenomas were significantly correlated with cuff adenomas formation. Duodenal adenomas were associated with pouch adenomas. There was some relationship between the development of cuff adenomas and the burden of colonic polyps, as well as the presence of duodenal adenomas. Conclusion: Adenomas in both the pouch and cuff commonly occur following IPAA, mandating lifelong annual endoscopic surveillance.

Keywords:
Ileal pouch anal anastomosis, Restorative proctocolectomy, Pouch adenoma, Cuff adenoma, Familial adenomatous polyposis, Adenoma
1.
Arvanitis ML, Jagelman DG, Fazio VW, Lavery IC, McGannon E: Mortality in patients with familial adenomatous polyposis. Dis Colon Rectum 1990;33:639-642.
2.
Warrier SK, Kalady MF: Familial adenomatous polyposis: challenges and pitfalls of surgical treatment. Clin Colon Rectal Surg 2012;25:83-89.
3.
Church J: Ileoanal pouch neoplasia in familial adenomatous polyposis: an underestimated threat. Dis Colon Rectum 2005;48:1708-1713.
4.
Tajika M, Niwa Y, Bhatia V, Tanaka T, Ishihara M, Yamao K: Risk of ileal pouch neoplasms in patients with familial adenomatous polyposis. World J Gastroenterol 2013;19:6774-6783.
5.
Tonelli F, Ficari F, Bargellini T, Valanzano R: Ileal pouch adenomas and carcinomas after restorative proctocolectomy for familial adenomatous polyposis. Dis Colon Rectum 2012;55:322-329.
6.
Parc YR, Olschwang S, Desaint B, Schmitt G, Parc RG, Tiret E: Familial adenomatous polyposis: prevalence of adenomas in the ileal pouch after restorative proctocolectomy. Ann Surg 2001;233:360-364.
7.
Wu JS, McGannon EA, Church JM: Incidence of neoplastic polyps in the ileal pouch of patients with familial adenomatous polyposis after restorative proctocolectomy. Dis Colon Rectum 1998;41:552-556; discussion 556-557.
8.
Friederich P, de Jong AE, Mathus-Vliegen LM, Dekker E, Krieken HH, Dees J, Nagengast FM, Vasen HF: Risk of developing adenomas and carcinomas in the ileal pouch in patients with familial adenomatous polyposis. Clin Gastroenterol Hepatol 2008;6:1237-1242.
9.
Heppell J, Weiland LH, Perrault J, Pemberton JH, Telander RL, Beart RW Jr: Fate of the rectal mucosa after rectal mucosectomy and ileoanal anastomosis. Dis Colon Rectum 1983;26:768-771.
10.
O'Connell PR, Pemberton JH, Weiland LH, Beart RW Jr, Dozois RR, Wolff BG, Telander RL: Does rectal mucosa regenerate after ileoanal anastomosis? Dis Colon Rectum 1987;30:1-5.
11.
van Duijvendijk P, Vasen HF, Bertario L, Bülow S, Kuijpers JH, Schouten WR, Guillem JG, Taat CW, Slors JF: Cumulative risk of developing polyps or malignancy at the ileal pouch-anal anastomosis in patients with familial adenomatous polyposis. J Gastrointest Surg 1999;3:325-330.
12.
Remzi FH, Church JM, Bast J, Lavery IC, Strong SA, Hull TL, Harris GJ, Delaney CP, O'Riordain MG, McGannon EA, Fazio VW: Mucosectomy vs. stapled ileal pouch-anal anastomosis in patients with familial adenomatous polyposis: functional outcome and neoplasia control. Dis Colon Rectum 2001;44:1590-1596.
13.
Tajika M, Nakamura T, Nakahara O, Kawai H, Komori K, Hirai T, Kato T, Bhatia V, Baba H, Yamao K: Prevalence of adenomas and carcinomas in the ileal pouch after proctocolectomy in patients with familial adenomatous polyposis. J Gastrointest Surg 2009;13:1266-1273.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.