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Ileal pouch-anal anastomosis as the first choice operation in patients with familial adenomatous polyposis: A tenyear experience
INTERNATIONAL
793
ABSTRACTS
Partial or total colomc mvolvement was present m all patients. The severity of the perianal lesion mirrored the activity of the bowel disease. Metronidazole improved lesions in some patients with mild and moderate degrees of perlana disease. but it was not helpful in any patient with severe disease. Patients with severe involvement had the most resistant disease, with 7 of 8 not Improving on &her medical treatment alone or m combination with surgery. Anal canal stricture was seen m 50% of the patients with severe perianal disease. Resection of the colonic disease did not affect perianal disease. Defunctionalizatlon of the rectum with fecal lverslon chd not affect perianal disease either. In such patients, proctocolectomy is needed to irradicate the problem.-Richard R. Ruzketts
right-sided colonic disease. Cholangiocarcinoma m Crohn’s disease is a rare occurrence. There does not appear to be the same increased risk of development of cholangiocarcmoma in Crohn’s disease as 1s reported for ulcerahve colitis. There 1s no clear-cut association between Crohn’s disease and lymphoma. carcinmd tumor, bladder or urinary tract tumors, or renal or renal cell carcinoma. An increased risk for the development of squamous cell carcinoma of the skin and of malignant melanoma has been described in Crohn’s disease.-Richard R. Rvketrs
Cyclosporine and Q-Mercaptopurine Crohn’s Colitis in Children. G. Mahdi, Am J Gasfroentervl91:1355-1359, (July),
The risk of development of colorectal cancer in patients with ulcerative colitis starts only 8 to 10 years after the onset of the disease. Durmg the second decade of pancolitis, colorectal cancer develops in about 0.5% of all patients. During the third and fourth decades, colorectal cancer develops m approximately 1% of patients per year. After 40 years of ulcerative colitis involving most of the colon. about 25% to 30% of all patients will have colorectal cancer unless they have a prophylcatic colectomy. In this study. the computerized database of the VA hospitals was used to compare the features of colorectal cancer in patients with and without underlymg inflammatory bowel disease (ulcerative colitis or Crohn’s disease). In the overall analysis, age and sclerosing cholangitis were both associated with an mcreased nsk of developing cancer of the colon or rectum. On the other hand. the chronic use of aspirin and other nonsteroidal anti-inflammatory drugs exerted a protective influence on the development of cancer. Although colorectal cancer occurred relatively more often in patients with inflammatory bowel disease than m those with ulcerative colitis or Crohn’s disease, m the multivariate analysis the type of inflammatory bowel disease &d not exert any significant influence. Cancer associated with inflammatory bowel disease occurred at a younger age than cancer in patients without mflammatory bowel disease. and it involved more proximal sites of the large bowel in patients with inflammatory bowel disease than m patients without, especially in patients with Crohn’s duease.-R&ard R. Ricketfs
for Active, Refractory D.M. Israel, arzd E. Hassall. 1996.
For most children with inflammatory bowel disease (ED), 5-ASA preparations and corticosteroids constitute the usual medical treatment. In selected cases, azathioprine or 6-MP may be used for their steroidsparing effects. This study was conducted to determine whether cyclosporine A (CSA) is effective in mducing remission m cluldren with severe, active Crohn’s cohi~ refractory to other medlcal treatment and to assess whether remissIon can be maintained by 6-MP and 5-ASA after chscontmuatlon of CSA. Ten children. 1.2 to 16 years of age (mean, 11 years). whose condition chd not respond to a 4-week treatment with IV methylprednisolone and TPN (three of whom were already recelvmg 6-MP) were given IV CSA and then switched to oral CSA when a clinical response was observed. There were seven responders to CSA. two responded after the first week of treatment, four after the second week, and one after the third week. Three patients relapsed while on full-dose CSA, and three patients did not respond to CSA at all. The six nonresponders and relapsers underwent ileostomy and subtotal colectomy (n = 3) or ileostomy and hermcolectomy (n = 3). Three of these children had received 6-MP before the administration of CSA. The authors conclude that CSA therapy is an effective and safe therapy for children with severe. achve Crohn’s colitis for whom steroid and 5-ASAtherapy have failed. CSA therapy 1s likely to fail in children who are already on 6-MP. The child and the family should be prepared for possible surgery because. m tlus study. 6 out of the 10 patients eventually had an operation.-Richard R. Rlcketts Malignancy in Crohn’s Gastroenferol91:-/34-440,
Disease. (March),
D. Bernstein 1996.
and A. Rogers.
Am J
The risk for the development of small bowel adenocarcinoma is greater in patients with Crohn’s disease than m the general population. although the magnitude of this risk 1s not clear. This study reviews the current literature regarding the association of various malignancies m Crohn’s disease. Multiple studies have failed to demonstrate any increased risk of the development of gastric carcmoma in Crobn‘s disease. Two population-based studies and several review articles have shown an increased risk for the development of small bowel adenocarcmoma in patients with Crohn’s disease. The risk is about six times that for the general population. The prognosis of adenocarcinoma of the small bowel complicating Crohn‘s disease 1s poor, with a ‘-year survival rate of less than 10%. Factors increasing the risk for the development of small bowel cancer m Crohn‘s disease include male sex, duration of disease, associated fistulous disease, and surgically excluded loops of bowel. The 1983 survey of the National Foundation for Ileitis and Colitis reported a sixfold greater nsk for the development of colorectal cancer m patients with Crohn’s disease than m the general population. However. several population-based studies have shown no association between these two con&tions. In spite of this. factors that have been postulated to increase the risk of colon cancer in Crohn’s disease include the age of onset, the presence of strictures and/or fistulae, and
Risk Factors of Colorectal Cancer Disease. F! Bansal and A. Sonnenberg. (January), 1996.
in Inflammatory Am .I Gastroenterol
Bowel 91.44-48
lleal Pouch-Anal Anastomosis as the First Choice Operation in Patients With Familial Adenomatous Polyposis: A TenYear Experience. A.H. Karfheusel: R. Part, C.P. Penna, et al. Surgery 119:615-623, (June), 1996. This study encompasses a lo-year experience with 171 patients who underwent proctocolectomy endorectal mucosectomy and construction of an ileal pouch reservoir (IPAA) and 23 patients who underwent ileorectal anastomosis (IRA) for familial adenomatous polypos~ (FAP). The study is important for pediatric surgeons because it documents, for a large group of patients, the presence of colorectal carcinoma. and compares the results of patients who had IPAAwlth those who had IRA. Of the 38 patients who were under 20 years of age, seven had adenocarcinoma. of which none was invasive. In patients over 21 years of age there was an increasing incidence of invasive carcinoma. The authors feel that because of the age-related risk of colorectal carcmoma, prophylactic surgery should be performed in asymptomatic patients before 20 years of age. Alarge number of patients (27%) had at least one postoperative complication. Fourteen patients required reoperation. There was a 15% incidence of bowel obstruction and a 4% incidence of pelvic sepsis. One hundred and one patients were monitored for over a year. There was no difference noted between postoperative morbidity and bowel function for the two procedures. The rates of daytime and nighttime continence were essentially the same. For this reason and because of the risk of rectal cancer after IRA (reported to be nearly 40% at 30 years), the authors recommend IPAA as the treatment of choice for patients with FAP.-Thomas R Tracy, Jr
793
ABSTRACTS
Partial or total colomc mvolvement was present m all patients. The severity of the perianal lesion mirrored the activity of the bowel disease. Metronidazole improved lesions in some patients with mild and moderate degrees of perlana disease. but it was not helpful in any patient with severe disease. Patients with severe involvement had the most resistant disease, with 7 of 8 not Improving on &her medical treatment alone or m combination with surgery. Anal canal stricture was seen m 50% of the patients with severe perianal disease. Resection of the colonic disease did not affect perianal disease. Defunctionalizatlon of the rectum with fecal lverslon chd not affect perianal disease either. In such patients, proctocolectomy is needed to irradicate the problem.-Richard R. Ruzketts
right-sided colonic disease. Cholangiocarcinoma m Crohn’s disease is a rare occurrence. There does not appear to be the same increased risk of development of cholangiocarcmoma in Crohn’s disease as 1s reported for ulcerahve colitis. There 1s no clear-cut association between Crohn’s disease and lymphoma. carcinmd tumor, bladder or urinary tract tumors, or renal or renal cell carcinoma. An increased risk for the development of squamous cell carcinoma of the skin and of malignant melanoma has been described in Crohn’s disease.-Richard R. Rvketrs
Cyclosporine and Q-Mercaptopurine Crohn’s Colitis in Children. G. Mahdi, Am J Gasfroentervl91:1355-1359, (July),
The risk of development of colorectal cancer in patients with ulcerative colitis starts only 8 to 10 years after the onset of the disease. Durmg the second decade of pancolitis, colorectal cancer develops in about 0.5% of all patients. During the third and fourth decades, colorectal cancer develops m approximately 1% of patients per year. After 40 years of ulcerative colitis involving most of the colon. about 25% to 30% of all patients will have colorectal cancer unless they have a prophylcatic colectomy. In this study. the computerized database of the VA hospitals was used to compare the features of colorectal cancer in patients with and without underlymg inflammatory bowel disease (ulcerative colitis or Crohn’s disease). In the overall analysis, age and sclerosing cholangitis were both associated with an mcreased nsk of developing cancer of the colon or rectum. On the other hand. the chronic use of aspirin and other nonsteroidal anti-inflammatory drugs exerted a protective influence on the development of cancer. Although colorectal cancer occurred relatively more often in patients with inflammatory bowel disease than m those with ulcerative colitis or Crohn’s disease, m the multivariate analysis the type of inflammatory bowel disease &d not exert any significant influence. Cancer associated with inflammatory bowel disease occurred at a younger age than cancer in patients without mflammatory bowel disease. and it involved more proximal sites of the large bowel in patients with inflammatory bowel disease than m patients without, especially in patients with Crohn’s duease.-R&ard R. Ricketfs
for Active, Refractory D.M. Israel, arzd E. Hassall. 1996.
For most children with inflammatory bowel disease (ED), 5-ASA preparations and corticosteroids constitute the usual medical treatment. In selected cases, azathioprine or 6-MP may be used for their steroidsparing effects. This study was conducted to determine whether cyclosporine A (CSA) is effective in mducing remission m cluldren with severe, active Crohn’s cohi~ refractory to other medlcal treatment and to assess whether remissIon can be maintained by 6-MP and 5-ASA after chscontmuatlon of CSA. Ten children. 1.2 to 16 years of age (mean, 11 years). whose condition chd not respond to a 4-week treatment with IV methylprednisolone and TPN (three of whom were already recelvmg 6-MP) were given IV CSA and then switched to oral CSA when a clinical response was observed. There were seven responders to CSA. two responded after the first week of treatment, four after the second week, and one after the third week. Three patients relapsed while on full-dose CSA, and three patients did not respond to CSA at all. The six nonresponders and relapsers underwent ileostomy and subtotal colectomy (n = 3) or ileostomy and hermcolectomy (n = 3). Three of these children had received 6-MP before the administration of CSA. The authors conclude that CSA therapy is an effective and safe therapy for children with severe. achve Crohn’s colitis for whom steroid and 5-ASAtherapy have failed. CSA therapy 1s likely to fail in children who are already on 6-MP. The child and the family should be prepared for possible surgery because. m tlus study. 6 out of the 10 patients eventually had an operation.-Richard R. Rlcketts Malignancy in Crohn’s Gastroenferol91:-/34-440,
Disease. (March),
D. Bernstein 1996.
and A. Rogers.
Am J
The risk for the development of small bowel adenocarcinoma is greater in patients with Crohn’s disease than m the general population. although the magnitude of this risk 1s not clear. This study reviews the current literature regarding the association of various malignancies m Crohn’s disease. Multiple studies have failed to demonstrate any increased risk of the development of gastric carcmoma in Crobn‘s disease. Two population-based studies and several review articles have shown an increased risk for the development of small bowel adenocarcmoma in patients with Crohn’s disease. The risk is about six times that for the general population. The prognosis of adenocarcinoma of the small bowel complicating Crohn‘s disease 1s poor, with a ‘-year survival rate of less than 10%. Factors increasing the risk for the development of small bowel cancer m Crohn‘s disease include male sex, duration of disease, associated fistulous disease, and surgically excluded loops of bowel. The 1983 survey of the National Foundation for Ileitis and Colitis reported a sixfold greater nsk for the development of colorectal cancer m patients with Crohn’s disease than m the general population. However. several population-based studies have shown no association between these two con&tions. In spite of this. factors that have been postulated to increase the risk of colon cancer in Crohn’s disease include the age of onset, the presence of strictures and/or fistulae, and
Risk Factors of Colorectal Cancer Disease. F! Bansal and A. Sonnenberg. (January), 1996.
in Inflammatory Am .I Gastroenterol
Bowel 91.44-48
lleal Pouch-Anal Anastomosis as the First Choice Operation in Patients With Familial Adenomatous Polyposis: A TenYear Experience. A.H. Karfheusel: R. Part, C.P. Penna, et al. Surgery 119:615-623, (June), 1996. This study encompasses a lo-year experience with 171 patients who underwent proctocolectomy endorectal mucosectomy and construction of an ileal pouch reservoir (IPAA) and 23 patients who underwent ileorectal anastomosis (IRA) for familial adenomatous polypos~ (FAP). The study is important for pediatric surgeons because it documents, for a large group of patients, the presence of colorectal carcinoma. and compares the results of patients who had IPAAwlth those who had IRA. Of the 38 patients who were under 20 years of age, seven had adenocarcinoma. of which none was invasive. In patients over 21 years of age there was an increasing incidence of invasive carcinoma. The authors feel that because of the age-related risk of colorectal carcmoma, prophylactic surgery should be performed in asymptomatic patients before 20 years of age. Alarge number of patients (27%) had at least one postoperative complication. Fourteen patients required reoperation. There was a 15% incidence of bowel obstruction and a 4% incidence of pelvic sepsis. One hundred and one patients were monitored for over a year. There was no difference noted between postoperative morbidity and bowel function for the two procedures. The rates of daytime and nighttime continence were essentially the same. For this reason and because of the risk of rectal cancer after IRA (reported to be nearly 40% at 30 years), the authors recommend IPAA as the treatment of choice for patients with FAP.-Thomas R Tracy, Jr