Skip to main content
2025 ASCRS Annual Scientific Meeting Main banner
Final Program


Visit ASCRS U
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
CME
CME
Invitation/Ticketed Event
Invitation/Ticketed Event
Invited Lectureship
Invited Lectureship
Award Recipient
Award Recipient
Self-Assessment
Self-Assessment
Social
Social
Industry
Industry
Back

Session: ePoster: IBD 2 (Sun1230)

EP443 - Restorative Proctocolectomy with IPAA for Patients with Dyplasia-Associated Ulcerative colitis is Associated with Higher Morbidity Compared to Medically Refractory Colitis

Sunday, May 11, 2025
12:51 PM – 12:56 PM PT
Location: Monitor 6, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • RD

    Reece K. DeHaan, MD

    Fellow
    Cleveland Clinic Foundation
    Cleveland Heights, Ohio, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • AK

    Arielle E. Kanters, MD, MS

    Colorectal Surgeoin
    Cleveland Clinic
    Cleveland, Ohio, United States

    Disclosure information not submitted.

  • Stefan D. Holubar, MD, MS, FACS, FASCRS

    Director of Research
    Cleveland Clinic
    Cleveland, Ohio, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

  • TQ

    Taha Qazi, MD

    Clinical Assistant Professor
    Cleveland Clinic
    Cleveland, Ohio, United States

    Disclosure information not submitted.

  • Scott R. Steele, MD, MBA

    President, Cleveland Clinic, Main Campus Submarket and Rupert B. Turnbull M.D., Endowed Chair in Colorectal Surgery
    Cleveland Clinic
    Cleveland, OH, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • David Liska, MD

    Associate Professor, Chair
    Department of Colorectal Surgery, Cleveland Clinic
    Cleveland Clinic, Cleveland, Ohio
    Cleveland, Ohio, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • OL

    Olga Lavryk, MD, PhD

    Staff, IBD Surgery Section
    Cleveland Clinic
    Cleveland, Ohio, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Reece K. DeHaan, MD: This individual has no financial relationships with ineligible companies.
Stefan D. Holubar, MD, MS, FACS, FASCRS: This individual has no relevant relationships with ineligible companies.
Scott R. Steele, MD, MBA: This individual has no financial relationships with ineligible companies.
Olga Lavryk, MD, PhD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Total abdominal colectomy is indicated in medically refractory ulcerative colitis (MRUC) and dysplasia-associated UC (DAUC) with minimal colitis symptoms or quiescent disease.). DAUC rarely requires treatment with immunomodulators or requires inpatient admission. We aimed to compare the outcomes of restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) between MRUC and DAUC.We hypothesized that IPAA outcomes are comparable between the two groups.

Methods/Interventions: Patients who underwent IPAA for UC based on pathological specimen evaluation were included. Patients with preoperatively diagnosed cancer were excluded. Patients were stratified into 2 groups: MRUC and DAUC - dysplasia in setting of UC. Patients' demographics, postoperative outcomes, retention of functional IPAA and quality of life were analyzed . Statistical analysis was completed using SPSS 27. Categorical variables were compared using Chi-squared testing and numerical variables were compared using Kruskal-Wallis testing. A p-value < 0.05 was considered significant

Results/Outcomes: A total of 2907 patients were identified, 2606 with MRUC and 301with DAUC. The MRUC group was younger at time of IPAA, had more females and higher BMI compared to DAUC (p <.001). MRUC patients required significantly more frequent treatment with steroids and immunomodulators compared to DAUC. Thus, MRUC group had more 3-staged IPAA (210, 49%) while those with DAUC had more 2-staged IPAA (n=276, 93%, p <.001). A minimally invasive approach was used more frequently in the management of MRUC (341, 13% p=0.042). There was significantly higher blood loss, intraoperative transfusion requirements and shorter operative duration for patients undergoing IPAA for DAUC (p=0.004, < 0.001 and 0.001, respectively). Although majority of the pouch configuration were J pouches, S-configured pouch was more frequently utilized in DAUC (46,15%) vs MRUC (224, 9%) as well as handsewn anastomoses (107,36% vs 224, 9% p<.001). Postoperative morbidity was higher in DAUC group vs MRUC. Anastomotic leak and stricture occurred more frequently in the DAUC compared to MRUC (Table) due to higher handsewn IPAA utilization. Pouchitis was significantly more prevalent in DAUC (124, 42%) vs MRUC(713, 29% p<.001). Pouch failure was not significantly different between MRUC (14, 5%) and DUC (121, 5% p=0.91).

Conclusion/Discussion: Patients undergoing IPAA for MRUC and DAUC have comparable pouch survival rates. However, patients with DAUC have higher rates of anastomotic leak, stricture and pouchitis. Likely, this arises from ongoing quiescent disease which despite remaining asymptomatic leads to pouch complications