Crohn’s Colitis Patients Should Never Be Offered an Ileoanal Pouch Asher Kornbluth, MD Clinical Professor of Medicine The Henry D. Janowitz Division of.

Slides:

Advertisements

Similar presentations

Crohn’s colitis patients can be offerred an ileoanal pouch

Advertisements

Monotherapy using 6-MP or azathioprine for Crohn’s disease is dead: out with the old and in with the new Stephen B. Hanauer, MD Professor of Medicine Clinical.

Immunomodulators and Biologics Maria T. Abreu, MD University of Miami Miller School of Medicine Miami, Florida.

Multimodality Therapy of Rectal Cancer Robert D. Madoff, MD University of Minnesota.

Imaging of Anal Fistula

Colitis in the Very Young

IBD & Pregnancy Christian Selinger Consultant Gastroenterologist.

A patient with severe Crohn's disease, an ileal stricture and proximal dilation on CTE should have medical therapy first Uma Mahadevan MD Professor of.

Perioperative anti-TNF biologics are not safe because they increase complications associated with surgery Feza H. Remzi FACS, FASCRS, FTTS ( Hon ) Chairman.

Challenges in Surgery for Severe, Refractory Ulcerative Colitis: Case Studies Phillip R. Fleshner,M.D. Shierley,Jesslyne,and Emmeline Widjaja Chair in.

Thiopurines still have a role in the management of pediatric IBD Athos Bousvaros MD, MPH Associate Director, IBD program Boston Children’s Hospital.

Dr. Drelichman Surgical Techniques Part 2. Crohn’s Disease Laparoscopic Colectomy - Results: Patient Outcomes Conversion Rate 5.9%

The Patient With Pyoderma Gangrenosum Maria T. Abreu, MD Chief, Division of Gastroenterology University of Miami Miller School of Medicine Miami, Florida.

Ghassan Wahbeh MD Associate Professor, Director IBD Program Seattle Children’s Hospital University of Washington.

Slawomir Marecik, MD, FACS, FASCRS Advocate Lutheran General Hospital, Park Ridge, IL Clinical Assistant Professor University of Illinois, Chicago, USA.

Asymptomatic UC patients on an immunomodulator with persistent moderate mucosal inflammation should either add a biologic or switch to a biologic William.

Crohn’s disease - A Review of Symptoms and Treatment

Malpractice Issues in IBD and How to Avoid Them: Advances in IBD 2014 Asher Kornbluth, MD Clinical Professor of Medicine The Henry D. Janowitz Division.

Outcome Following Limb Salvage Surgery and External Beam Radiotherapy for High Grade Soft Tissue Sarcomas of the Groin and Axilla Rapin Phimolsarnti M.D.

Cedars-Sinai Medical Center Los Angeles, California

Patient Selection for IAP Nigel A. Scott MD FRCS Manchester UK.

Colonoscopy; Surveillance Indications

Should colonoscopy be performed one year out from colorectal cancer resection? Alexandra Kent, Philip Thompson, Prof Alan Horgan, Mr Paul Hainsworth Newcastle.

Medical Management of Ulcerative Colitis Conrad Beckett Bradford Royal Infirmary M62 Course March 2006.

Hand Assisted Surgery Bradley R. Davis, MD, FACS, FASCRS Associate Professor of Surgery Director Surgical Education/Surgical Skills Lab Program Director.

Dr. Angus Lee SET 1 General Surgery. Burrill Crohn, an American Gastroenterologist, with his 2 other colleagues first described “Terminal ileitis” in.

Department of Colorectal Surgery John Radcliffe Hospital, Oxford

M62 Course 2006 The Failing Pouch

Neonates (children less than one month of age) have immature immune systems and are at higher risk for serious complications of bacterial and viral infections,

Complications of Laparoscopic Surgery for Diverticulitis

CP The Evolving Role of Surgery in IBD John Pemberton Advances in IBD, December, 2012 The Evolving Role of Surgery in IBD John Pemberton Advances.

T4 Colon Cancer and Laparoscopic Approach Gustavo Plasencia MD FACS, FASCRS Clinical Professor of Surgery Gustavo Plasencia MD FACS, FASCRS Clinical Professor.

“Antibiotics and corticosteroids: Indications and approaches”

Division of General Surgery, St Paul's Hospital Z. Rahimi M. Hoorzad American journal of surgery, May 2010.

The Natural History of Inflammatory Bowel Disease and Pregnancy.

Fistulotomy and Setons Mr Graham Williams Consultant Colorectal Surgeon Royal Wolverhampton Hospitals NHS Trust.

Management of the Problem Pouch

Aminosalicylates in IBD: New Data on an Old Therapy Joel R. Rosh, MD Director, Pediatric Gastroenterology Goryeb Children’s Hospital/Atlantic Health Professor.

M62 Course April SURGERY for COLONIC CROHN’S DISEASE RJ NICHOLLS.

Pro: Perioperative anti-TNF Biologics are safe and do not increase complications associated with surgery. Miguel Regueiro, M.D. Professor of Medicine Associate.

SYNCHRONOUS COLORECTAL AND LIVER RESECTION J Peter A Lodge MD FRCS HPB and Transplant Unit St James’s University Hospital Leeds LS9 7TF 2006 Association.

The only end-points of therapy that matter are mucosal healing, normal blood work, and negative radiologic studies. Robert N. Baldassano, MD Colman Family.

DIFFICULT SMALL BOWEL CROHN’S DISEASE John Northover St Mark’s Hospital, London.

IBD Cases Stephen B. Hanauer, MD Professor of Medicine Feinberg School of Medicine Medical Director, Digestive Health Center.

Chronic Illness and the Life Course: the case of Ulcerative Colitis Professor Mike Kelly Health Development Agency and the London School of Hygiene and.

Crohn’s Colitis SR Brown Colorectal Surgeon Sheffield Teaching Hospitals.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of colorectal cancer: case report and literature review Alexandra.

You Can Never Stop a Biologic

Anastomosis in IBD Barry Salky, MD FACS Professor of Surgery Chief (Emeritus), Division of Laparoscopic Surgery The Mount Sinai Hospital New York.

Mamoun A. Rahman Surgical SHO Mr Osborne’s team. Introduction Blood transfusion: -Preoperative ( elective) -Intra/postoperative ( urgent) Blood transfusion.

Radical surgery is the preferable treatment option for T1- 2/N0 low rectal cancer Jose G. Guillem, MD, MPH Department of Surgery Memorial Sloan Kettering.

Important questions As good or better ? Cost effective ? Overall, safer? Is it safe as a cancer operation? Can all surgeons do it? Compare to open surgery.

Oxford Colorectal People, Pouches and Places:The Generation Game - Pouch Salvage and Reconstruction Prof Neil Mortensen MA, MB ChB, MD, FRCS Eng hon FRCS.

Early Administration of Azathioprine Versus Conventional Management of Crohn’s Disease : A Randomized Controlled Trial F1. Ja Won Koo JACQUES COSNES, ANNE.

Ileoanal Pull-Through Straight vs. J Pouch

Fecal Calprotectin Predicts the Clinical Course of Acute Severe Ulcerative Colitis R2 이 홍 주 Am J Gastroenterol 2009 ; 104 : 673 ~ 678.

Surgical treatment of inflammatory bowel disease Aleš Tomažič Dept. of Abdominal Surgery, University Medical Center Ljubljana.

Laparoscopic surgery for rectal cancer What is the evidence?

Mechanical bowel preparation with oral antibiotics reduces surgical site infection and anastomotic leak rate following elective colorectal resections.

Ulcerative Colitis (UC)-Associated Colorectal Cancer (CRC) Patients Who Receives Colorectal Surgery More Likely Receive Blood Transfusion Than Crohn’s.

New insights in the natural history of PSC

IBD recent advances in surgery

Figure 3. Evidence on preoperative enteral nutrition

J.Livie1, E.Goodall1, M.Wilson2,C.Payne2 Department of Surgery2

Kangaroo Club Information Day

Basics of PSC Christopher L. Bowlus, MD

Raymond Cross, MD, MS, AGAF Associate Professor of Medicine

Significance of Periprocedural Myocardial Infarctions in Percutaneous Coronary Interventions A New Look at an Old Topic Abhiram Prasad, MD, FRCP, FESC,

Presentation data from US VICTORY Consortium

Risk factors for postoperative infection after lower gastrointestinal surgery in patients with inflammatory bowel disease: Findings from a large epidemiological.

Presentation transcript:

Crohn’s Colitis Patients Should Never Be Offered an Ileoanal Pouch Asher Kornbluth, MD Clinical Professor of Medicine The Henry D. Janowitz Division of Gastroenterology The Icahn School of Medicine at Mount Sinai

Last Year’s Debate: 22 year old, Severe UC Failing 5 Days IV Steroids Their Position: Infliximab 5 mg/kg and subtotal colectomy if no improvement in 5 days

My Prior Debates: 22 year old, Severe UC Failing 5 Days IV Steroids Bedside Commode Start Kosher Diet

To Make

It Fair

For Our

Surgeon Friends

I’ll Try

To Speak

Slowly

And with only

1 or

Maybe 2

Syllables

Per

Word

Problems with Pouches in Patients with Crohn’s disease The problem of symptoms The problem of local complications The problem of major complications The problem of pouch failure and excision

Problems with Pouches in Patients with Crohn’s disease The problem of symptoms The problem of local complications The problem of major complications The problem of pouch failure and excision

Increased symptoms in Crohn’s disease pouches Shen B, Am J Gastro 2005; 100:

Increased symptoms in patients with pre- op perineal disease Richard et al, Dis Colon Rectum, 1997

Problems with Pouches in Patients with Crohn’s disease The problem of symptoms The problem of local complications The problem of major complications The problem of pouch failure and excision

Pouch Fistula in Crohn’s disease Shen, et al CGH 2008

Perianal complications in patients with pre-op Crohn’s disease Richard et al, Dis Colon Rectum, 1997

Fistula – Free Survival Analysis: IC-UC vs. IC-Crohn’s disease/Crohn’s disease Tekkis PP, et al. Colorectal Disease 2005; 7: 218

Problems with Pouches in Patients with Crohn’s disease The problem of symptoms The problem of local complications The problem of major complications The problem of pouch failure and excision

Meta Analysis: Major Complications of the Pouch in Patients with Crohn’s disease

Meta Analysis of Crohn’s disease pouch outcomes: Highest quality series Reese GE, et al. Dis Colon Rectum 2007; 50:239

Meta Analysis of Crohn’s disease pouch outcomes: More Recent Series Reese GE, et al. Dis Colon Rectum 2007; 50:239

Meta Analysis of Crohn’s disease pouch outcomes: Most experienced surgeons Reese GE, et al. Dis Colon Rectum 2007; 50:239

Problems with Pouches in Patients with Crohn’s disease The problem of symptoms The problem of local complications The problem of major complications The problem of pouch failure and excision

Pouch Failure Rate: Crohn’s disease vs. UC Brown CR, et al. Dis Colon Rectum 2005; 48: 1542

Pouch Survival: IC-UC vs. IC- Crohn’s disease, or CD Tekkis PP, et al. Colorectal Disease 2005; 7: 218

Risk factors for pouch failure: The Cleveland Clinic experience Fazio VW, et al. Ann Surgery 2003; 4:238

Planned Ileoanal Pouches for Crohn’s disease: Conclusions Pre-operative diagnosis of Crohn’s disease increases postoperative complications –Pouch fistula –Pelvic sepsis –Pouch failure! Multivariate analysis controlling for other variables likewise predict pre-op Crohn’s disease as predictor of increased pouch failure rate Increased incidence of poor outcomes in Crohn’s disease pouches are more common even in the most experienced centers

Thank You For Your Attention