P0725 - Assessing the Impact of Interval Duration Between Ileal Pouch Creation and Loop Ileostomy Closure on the Development of Subsequent Inflammatory Pouch Conditions in Patients with Ulcerative Colitis

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Katherine E. Westbrook, DO

Cleveland Clinic Foundation
Shaker Heights, OH

Katherine E. Westbrook, DO¹, Joseph Carter Powers, BA², Mark Zemanek, DO¹, Emma Dester, ², Qijun Yang, MS³, Ben Cohen, MD, MAS⁴, Florian Rieder, MD⁴, Tracy L. Hull, MD⁵, Miguel D. Regueiro, MD⁶, Taha Qazi, MD⁶
¹Cleveland Clinic Foundation, Cleveland, OH; ²Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH; ³Lerner Research Institute, Cleveland, OH; ⁴Cleveland Clinic, Cleveland, OH; ⁵Cleveland Clinic, Chagrin Falls, OH; ⁶Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH

Introduction: The prime surgical management strategy for medically refractory ulcerative colitis (UC) is an ileal pouch – anal anastomosis (IPAA). Surgical practice often includes the creation of a temporary loop ileostomy (LI) with subsequent closure. The impact of the interval between IPAA and LI closure regarding endoscopic pouch inflammation has not been well defined. The aim for this project was to assess if delayed LI closure places patients at higher risk of endoscopic inflammatory pouch diseases (EIPD).

Methods: This is a retrospective cohort study that assessed patients with UC that underwent IPAA with LI closure between January 2010 and December 2020. Patients were divided into 2 groups - early (0-118 days) or late closure (greater than 180 days) – based on interval between IPAA and LI closure. The primary outcome was development of EIPD, which was a composite of pouch disease activity index (PDAI) score of greater than or equal to 4, mucosal breaks not limited to anastomotic lines, or diffuse pouch inflammation. Secondary outcomes included development of strictures, fistulas, inflammation of the rectal cuff, and individual components of the primary outcome.

Results: 379 patients were included in the analysis. Controlling for other factors, multivariable logistic regression analysis showed that patients that underwent late closure had greater odds of developing EIPD compared to patients that underwent early closure (OR = 1.92, 95% CI 1.06, 3.51, p = 0.033). The late closure group also had higher odds of having strictures (pouch, pouch inlet, neoterminal ileum) or fistulas (perianal, anal-vaginal, pouch vaginal, entero-enteric, enterovaginal, tip of J/efferent limb) than the early closure group (OR = 2.42, 95% CI 1.09,5.23, p = 0.026). In contrast, longer duration of IBD prior to surgery was protective against the development of EIPD and complications. Of the patients in the late-closure group, 29 (40%) patients had delayed closure due to non-medical reasons (patient preference), 16 (22%) had delayed closure for infectious complications (sepsis, abscess, leak), and the remaining 28 (38%) had delayed closure due to non-infectious medical reasons (cancer therapy, fistula repair).

Discussion: Patients with a late LI closure had a higher odds of developing EIPD, strictures and fistulas as compared to early closure. Post-operative complications leading to LI closure delay may affect the future development of EIPD and IPAA complications.

Characteristic OR 95% CI p-value

Time Between IPAA and ileostomy closure Early Late	1.92	1.06, 3.51	0.033
History of PSC No Yes	0.33	0.10,1.00	0.061
Extraintestinal Manifestations No Yes	2.50	1.48, 4.27	< 0.001
IBD Distribution Pan-colitis Left Sided Colitis/ Proctitis	0.58	0.25,1.25	0.178
Pre-Surgery BMI Underweight/Normal Weight Overweight	0.62	0.36,1.05	0.076
Duration of IBD Prior to Colectomy (Years)	0.96	0.93, 0.99	0.018

Table: Table 1. Multivariable Logistic Regression for Development of Endoscopic Pouch Inflammation

Disclosures:

Katherine Westbrook indicated no relevant financial relationships.

Joseph Carter Powers indicated no relevant financial relationships.

Mark Zemanek indicated no relevant financial relationships.

Emma Dester indicated no relevant financial relationships.

Qijun Yang indicated no relevant financial relationships.

Ben Cohen indicated no relevant financial relationships.

Florian Rieder: 89Bio – Advisory Committee/Board Member, Consultant. Abbvie – Advisory Committee/Board Member, Consultant. Adnovate – Advisory Committee/Board Member, Consultant. Agomab – Advisory Committee/Board Member, Consultant. Allergan – Advisory Committee/Board Member, Consultant. Arena – Advisory Committee/Board Member, Consultant. Boehringer Ingelheim – Advisory Committee/Board Member, Consultant. CDISC – Advisory Committee/Board Member, Consultant. Celgene/Bristol Myers Squibb – Advisory Committee/Board Member, Consultant. Ferring – Advisory Committee/Board Member, Consultant. Galapagos – Advisory Committee/Board Member, Consultant. Galmed Pharmaceuticals – Advisory Committee/Board Member, Consultant. Genentech – Advisory Committee/Board Member, Consultant. Gilead – Advisory Committee/Board Member, Consultant. Gossamer – Advisory Committee/Board Member, Consultant. Guidepoint – Advisory Committee/Board Member, Consultant. Helmsley – Advisory Committee/Board Member, Consultant. Horizon Therapeutics – Advisory Committee/Board Member, Consultant. Image Analysis Limited – Advisory Committee/Board Member, Consultant. Index Pharmaceuticals – Advisory Committee/Board Member, Consultant. Janssen – Advisory Committee/Board Member, Consultant. Koutif Therapeutics – Advisory Committee/Board Member, Consultant. Mestag Therapeutics – Advisory Committee/Board Member, Consultant. Metacrine – Advisory Committee/Board Member, Consultant. Morphic Therapeutic – Advisory Committee/Board Member, Consultant. Organovo – Advisory Committee/Board Member, Consultant. Origo – Advisory Committee/Board Member, Consultant. Pfizer – Advisory Committee/Board Member, Consultant. Pliant – Advisory Committee/Board Member, Consultant. Prometheus Biosciences – Advisory Committee/Board Member, Consultant. Receptos – Advisory Committee/Board Member, Consultant. REDX – Advisory Committee/Board Member, Consultant. Roche – Advisory Committee/Board Member, Consultant. Samsung – Advisory Committee/Board Member, Consultant. Surmodics – Advisory Committee/Board Member, Consultant. Surrozen – Advisory Committee/Board Member, Consultant. Takeda – Advisory Committee/Board Member, Consultant. TD Cowen – Advisory Committee/Board Member, Consultant. Techlab – Advisory Committee/Board Member, Consultant. Theravance – Advisory Committee/Board Member, Consultant. Thetis Pharmaceuticals – Advisory Committee/Board Member, Consultant. UCB – Advisory Committee/Board Member, Consultant. Ysios Capital – Advisory Committee/Board Member, Consultant.

Tracy Hull indicated no relevant financial relationships.

Miguel Regueiro: Abbvie – Advisory Committee/Board Member, Consultant. BMS – Advisory Committee/Board Member, Consultant. Janssen – Advisor or Review Panel Member. Lilly – Advisory Committee/Board Member, Consultant. Pfizer – Advisory Committee/Board Member, Consultant. Takeda – Advisory Committee/Board Member, Consultant.

Taha Qazi: Abbvie – Advisor or Review Panel Member, Speakers Bureau. BMS – Advisor or Review Panel Member, Speakers Bureau. Itierative Scope – Advisor or Review Panel Member. Janssen – Speakers Bureau.

Katherine E. Westbrook, DO¹, Joseph Carter Powers, BA², Mark Zemanek, DO¹, Emma Dester, ², Qijun Yang, MS³, Ben Cohen, MD, MAS⁴, Florian Rieder, MD⁴, Tracy L. Hull, MD⁵, Miguel D. Regueiro, MD⁶, Taha Qazi, MD⁶. P0725 - Assessing the Impact of Interval Duration Between Ileal Pouch Creation and Loop Ileostomy Closure on the Development of Subsequent Inflammatory Pouch Conditions in Patients with Ulcerative Colitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.