Skip to Main Content

Pouchoscopy

++

Overview

++

Instrumentation (rigid or flexible) of existing pouch (ileoanal pouch, continent ileostomy) for evaluation or treatment (eg, dilation of stricture, decompression, tube insertion, etc).

++

Indication based on symptoms (ie, pouch dysfunction, pouchitis) or for routine surveillance of pouch and ATZ for dysplasia, polyps, or cancer (particularly in FAP).

++

Circumstances dictate whether flexible or rigid instrument preferable. Sedation and analgesia are commonly not needed but occasionally preferable in very sensitive patient (eg, traumatized perianal skin, etc).

++

Alternatives

++

Pouchogram: contrast x-ray.

++

Indications

++

  • • IBD: every 1–3 years or when symptomatic and not responding to conservative treatment, surveillance of ATZ cuff every 1–3 years.
  • • FAP: every year.

++

Preparation

++

Diagnostic: possibly 1 Fleet enema right before test (if poor visibility).

++

Therapeutic: none.

++

Advantages

++

Combination of evaluation, biopsy, and (limited) intervention.

++

No lengthy preparation needed.

++

Limitations and Risks

++

  • • Pathology missed (inadequate visibility, pocket).
  • • Perforation: low risk.
  • • Bleeding: depending on pathology/intervention, minimal for diagnostic.
  • • Exact orientation difficult/impossible.

++

Characteristic Features

++

Pathology: pouchitis, lymphoid hyperplasia (Peyer plaques), dysplasia, formation of polyps/tumor, mass (more likely in posterior area), acute and chronic inflammation, ulcerations (→ suggestive of Crohn disease if ulcerations in afferent limb), length of efferent limb (eg, S-pouch), friability of ATZ, length and configuration of valve segment (continent ileostomy), fistula opening.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.