P159. Proctocolectomy-ileal pouch-anal anastomosis for ulcerative colitis may increase prevalence of primary sclerosing cholangitis with dominant stricture in a short period like 24 months
M. Basaranoglu, M. Mahmut Yüksel, G. Gürel Nesser, N. Turhan, Türkiye Yüksek Ihtisas Hospital, Gastroenterology, Ankara, Turkey
Up to 90% of patients with IBD have PSC. We questioned whether proctocolectomy-ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) has an effect on the development of PSC in patients with UC. Additionally, the prevalence of HCC, pancreatobiliary cancers and neuroendocrine tumor (NET) had been investigated.
We evaluated the medical records of 146 patients with IBD who undergoing proctocolectomy-IPAA betwen the years 1995 and 2011. Each patient was questioned by clinical, labarotory and imaging examinations and finally pathology records for the existence of PSC and any hepatopancreatobiliary tumor and NET.
59 UC patients with IPAA had full records for further evaluations. All of the patients, except one, had normal serum ast, alt, alp, and ggt levels and abdominal ultrasound examination before the operation. We found 4 patients with PSC. Only one was diagnosed before the operation (44 years old). The rest, 3 patients, were diagnosed after the IPAA operation. Interestingly, approximately 12 months later, these patients developed either liver enzyme abnormalities or pruritis and further examination showed PSC. In one (31 years-old, female), mrcp was normal at the beginning, psc was then diagnosed by liver biopsy. 24 months following the IPAA, MRCP and ERCP showed dominant stricture, no cholangiocancer during the follow-up. The other one (35 years old) developed serum alp/ggt abnormalities, then MRCP showed PSC. The last case had UC complicated with rectum cancer, operated and 1 year later (53 years old) developed enzyme abnormalities and psc with dominant stricture diagnosed by both MRCP and ERCP. Only 2 pateints were dead due to complications of IPAA operation during the follow-up.
We also evaluated whether hepatopancreatobiliary cancers and NET was increased in this study. Nobody developed HCC, cholangio or gallblader and pancreas cancer or NET. In addition to the case above mentioned, we found 3 patients with colon cancer on the pathologic examination.
According to the our IBD registration, of the 2200 patients with IBD in our IBD center, 41 patients (1.6%) had PSC and DS was diagnosed in 34%.
Our results showed that the prevalence of PSC was increased by the existence of proctocolectomy-IPAA procedure in patients with UC, in a short period like 12 months. Of the 3 patients developed PSC after the operation, 2 had dominant stricture that was developed in a short period like 24 months. This experience suggests that proctocolectomy-IPAA procedure can be formed in UC patients after the careful monitoring for the hepatobiliary conditions, even by liver biopsy in risky patients.