Diagnosis and Treatment of Pouch Disorders in Children: A Systematic Review.

BACKGROUND: Restorative proctocolectomy and ileal pouch anal anastomosis has become the surgical procedure of choice in pediatric patients with medically-refractory ulcerative colitis or familial adenomatous polyposis. This systematic review aims to assess the diagnosis and treatment of pouch disorders in pediatric patients who undergo ileal pouch anal anastomosis.

METHODS: A literature search was performed on MEDLINE, Google Scholar and EMBASE for all publications describing outcomes of pediatric ileal pouch anal anastomosis. Studies between January 1, 2000 and September 7, 2022 published in English were included. Studies were excluded based on title, abstract and full-length review.

RESULTS: Thirty-three studies were included in this review, all of which were retrospective in nature. The outcomes of 2643 pediatric patients were included in the 33 studies. Pouch disorders described include anastomotic leaks, pouch strictures, pouch failure, pouchitis, cuffitis and de novo Crohn's disease of the pouch.

CONCLUSIONS: The reported incidence of disorders of the pouch in children varies widely and is likely attributable to differences in definitions and follow-up periods across studies. Pouchitis was the most frequently described outcome. The overall rate of pouch failure in children is relatively low with de novo Crohn's disease of the pouch the most significant risk factor. Management is largely informed by clinical practices in adult patients with scant data on treatment efficacy in children. Multicenter, prospective studies are needed in the pediatric population in order to accurately identify risk factors, standardize the assessment of pouch complications, and determine effective treatment strategies. See 20-minute symposium video.