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Open Access 18-01-2025 | Ulcerative Colitis | Review

Medical, Endoscopic, and Surgical Treatments for Rectal Cuffitis in IBD Patients with an Ileal Pouch-Anal Anastomosis: A Narrative Review

Authors: Joseph Carter Powers, Emma Dester, Mary Schleicher, Benjamin Cohen, Bret Lashner, Andrei I. Ivanov, Tracy Hull, Katherine Falloon, Taha Qazi

Published in: Digestive Diseases and Sciences

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Abstract

Background

Ulcerative colitis patients who undergo ileal pouch-anal anastomosis (IPAA) without mucosectomy may develop inflammation of the rectal cuff (cuffitis). Treatment of cuffitis typically includes mesalamine suppositories or corticosteroids, but refractory cuffitis may necessitate advanced therapies or procedural interventions. This review aims to summarize the existing literature regarding treatments options for cuffitis.

Methods

A broad search strategy was created by a medical librarian to capture cuffitis in IPAA patients. A total of 1877 citations were identified, and 957 studies remained after removal of 920 duplicates. Two reviewers screened all 957 abstracts and 294 full-text articles to determine if they were eligible for inclusion in this review.

Results

Twenty-three studies met the inclusion criteria. Medical interventions were investigated in 16 studies with mesalamine and corticosteroid regimens being the most common, followed by ustekinumab, vedolizumab, hyperbaric oxygen, tofacitinib, risankizumab, and infliximab. Studies investigating mesalamine and corticosteroid use generally had larger samples (ranging 4–120 patients) and showed symptomatic improvement in 52–100% of patients and decreases of 1.14–1.8 points in endoscopic disease activity indices. In contrast, advanced therapy studies had small samples (ranging 1–21 patients) and variable responses.
Seven studies explored endoscopic and surgical approaches including secondary mucosectomy, cuff resection, needle-knife therapy, and balloon dilation for concomitant outlet strictures. These techniques generally resulted in symptomatic resolution but were limited by small samples (ranging 3–40 patients).

Conclusion

Studies evaluating therapies used to treat cuffitis suggest benefit from conventional mesalamine or corticosteroid-based therapies, whereas data regarding advanced therapies and interventional procedures are inconsistent given small sample sizes.

Graphical Abstract

Appendix
Available only for authorised users
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Metadata
Title
Medical, Endoscopic, and Surgical Treatments for Rectal Cuffitis in IBD Patients with an Ileal Pouch-Anal Anastomosis: A Narrative Review
Authors
Joseph Carter Powers
Emma Dester
Mary Schleicher
Benjamin Cohen
Bret Lashner
Andrei I. Ivanov
Tracy Hull
Katherine Falloon
Taha Qazi
Publication date
18-01-2025
Publisher
Springer US
Published in
Digestive Diseases and Sciences
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-024-08822-x