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P183. Outcomes after ileal pouch anal anastomosis in patients with primary sclerosing cholangitis

M. Pavlides1, M. Rahman1, J. Cleland1, R. Gaunt2, S. Travis1, N. Mortensen3, R. Chapman1, 1University of Oxford, Translational Gastroenterology Unit, Oxford, United Kingdom, 2University of Oxford, Statistics, Oxford, United Kingdom, 3University of Oxford, Nuffield Department of Surgery, Oxford, United Kingdom

Background

The function and quality of life (QoL) outcomes in patients with Primary Sclerosing Cholangitis (PSC) and Ulcerative Colitis (UC) who undergo Ileal Pouch Anal Anastomosis (IPAA) are not well established. Reports conflict about the incidence of pouchitis in patients with PSC and IPAA, with few data on QoL. This study investigated function and QoL outcomes in patients with PSC and IPAA.

Methods

Patients with PSC-associated UC who underwent IPAA (PSC-IPAA) and patients with UC without PSC who underwent IPAA (UC-IPAA) between 1983 and 2012 were compared for pouch dysfunction, acute pouchitis, surgical complications, incidence of pouch dysplasia/cancer and biologic therapies/immunomodulators for treating pouch dysfunction. Baseline demographic and surgical characteristics were recorded. The Cleveland Global Quality of Life Questionnaire (CGQOL) and the Öresland score were used to assess the self-reported impact of IPAA on QoL and pouch function. QoL was also assessed by the SF-36 questionnaire, including a reference group of patients with PSC-associated UC without IPAA (PSC-UC).

Results

13 patients with PSC and 79 patients with UC underwent IPAA in this period. More patients with PSC had pancolitis (62% vs 30%) and more underwent colectomy for dysplasia/cancer (23% vs 3%). Trends for more patients with PSC-IPAA to suffer pouch dysfunction (69% vs 47%; p = 0.231), acute pouchitis (46% vs 20%; p = 0.073) or receive biologic/immunomodulator therapy (23% vs. 5%; p = 0.06) were not significant. Normal Q-Q plots to check the assumption of normality for the Öresland score gave a plausible linear relationship so a two sample t-test was used to compare the means of the two groups. The mean Öresland score for PSC-IPAA was 7.0 compared to 5.6 for UC-IPAA (p = 0.07). The mean CGQOL scores were 0.73 for PSC-IPAA and 0.75 for UC-IPAA (p = 0.63). Mean Physical Health Summary (PCS) and Mental Health Summary (MCS) scores from SF-36 for PSC-IPAA vs UC-IPAA were 41.9 vs 48.0 (p = 0.04) and 41.4 vs 47.6 (p = 0.03), respectively. The mean PCS and MCS scores for patients with PSC-UC were 44.4 (p = 0.65 vs PSC-IPAA; p = 0.11 vs UC-IPAA) and 43.5 (p = 0.33 vs PSC-IPAA; p = 0.07 vs UC-IPAA).

Conclusion

Patients with PSC-IPAA have a trend to worse pouch function compared to patients without PSC, although this did not reach statistical significance, probably due to small numbers. QoL in patients with PSC-IPAA assessed by SF-36 and pouch function assessed by the Öresland score are significantly worse compared to patients with UC-IPAA.