The prevalence of pouch fistulas in ulcerative colitis following restorative proctocolectomy: a systematic review and meta-analysis.

IF 3.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Intestinal Research Pub Date : 2024-08-09 DOI:10.5217/ir.2024.00009

Sheng Wei Lo, Ishaan Dharia, Danujan Sriranganathan, Maia Kayal, Edward L Barnes, Jonathan P Segal

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Abstract

Background/aims: One complication of restorative proctocolectomy with ileo-anal pouch anastomosis is fistula formation in the pouch. Fistulas can be associated with significant morbidity and pouch failure. We conducted a systematic review with meta- analysis to try and understand the prevalence of pouch fistulas in patients with ulcerative colitis following restorative proctocolectomy.

Methods: The Embase, Embase Classic, and PubMed databases were searched between January 1979 and April 2022. Studies were included if there were cross-sectional, case-controlled, population-based or cohort studies reporting on prevalence of pouch fistulas in ulcerative colitis. Studies had to report the number of patients with pouch fistulas using either clinical, endoscopic, or radiological diagnosis in an adult population.

Results: Thirty-three studies screened met the inclusion criteria. The pooled prevalence of developing at least 1 fistula was 0.05 (95% confidence interval [CI], 0.04-0.07). The pooled prevalence of pouch failure in patients with pouch fistula was found to be 0.24 (95% CI, 0.19-0.30). The pooled prevalence of developing a pouch fistula at 3 years, 5 years and more than 5 years was 0.04 (95% CI, 0.02-0.07), 0.05 (95% CI, 0.02-0.07), and 0.05 (95% CI, 0.02-0.10), respectively.

Conclusions: This is the first systematic review and meta-analysis to report the prevalence of pouch fistula. It also provides a pooled prevalence of pouch failure in these patients. These results can help to shape future guidelines, power future studies, and help counsel patients.

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恢复性直肠结肠切除术后溃疡性结肠炎患者肠袋瘘的发病率：系统综述和荟萃分析。

背景/目的：修复性直肠结肠切除术与回肠肛门袋吻合术的并发症之一是袋内瘘管的形成。瘘管可能与严重的发病率和肛袋失败有关。我们进行了一项系统性综述和荟萃分析，试图了解溃疡性结肠炎患者在接受直肠切除术后瘘管的发生率：方法：检索了1979年1月至2022年4月期间的Embase、Embase Classic和PubMed数据库。如果有横断面研究、病例对照研究、基于人群的研究或队列研究报告了溃疡性结肠炎肠袋瘘的发病率，则纳入研究。研究必须通过临床、内窥镜或放射学诊断报告成年人群中溃疡性结肠炎瘘患者的数量：筛选出的 33 项研究符合纳入标准。至少出现 1 个瘘管的汇总患病率为 0.05（95% 置信区间 [CI]，0.04-0.07）。在瘘袋患者中，瘘袋失败的总体发生率为 0.24（95% 置信区间 [CI]，0.19-0.30）。3年、5年和5年以上出现瘘袋的汇总患病率分别为0.04（95% CI，0.02-0.07）、0.05（95% CI，0.02-0.07）和0.05（95% CI，0.02-0.10）：这是首次对肛门袋瘘患病率进行系统回顾和荟萃分析。它还提供了这些患者中瘘袋失败的总发生率。这些结果有助于制定未来的指南、推动未来的研究并为患者提供咨询。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Intestinal Research GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

7.40

自引率

10.20%

发文量

审稿时长

38 weeks

期刊介绍： Intestinal Research (Intest Res) is the joint official publication of the Asian Organization for Crohn''s and Colitis (AOCC), Chinese Society of IBD (CSIBD), Japanese Society for IBD (JSIBD), Korean Association for the Study of Intestinal Diseases (KASID), Taiwan Society of IBD (TSIBD) and Colitis Crohn''s Foundation (India) (CCF, india). The aim of the Journal is to provide broad and in-depth analysis of intestinal diseases, especially inflammatory bowel disease, which shows increasing tendency and significance. As a Journal specialized in clinical and translational research in gastroenterology, it encompasses multiple aspects of diseases originated from the small and large intestines. The Journal also seeks to propagate and exchange useful innovations, both in ideas and in practice, within the research community. As a mode of scholarly communication, it encourages scientific investigation through the rigorous peer-review system and constitutes a qualified and continual platform for sharing studies of researchers and practitioners. Specifically, the Journal presents up-to-date coverage of medical researches on the physiology, epidemiology, pathophysiology, clinical presentations, and therapeutic interventions of the intestinal diseases. General topics of interest include inflammatory bowel disease, colon and small intestine cancer or polyp, endoscopy, irritable bowel syndrome and other motility disorders, infectious enterocolitis, intestinal tuberculosis, and so forth. The Journal publishes diverse types of academic materials such as editorials, clinical and basic reviews, original articles, case reports, letters to the editor, brief communications, perspective, statement or commentary, and images that are useful to clinicians and researchers.