EP661 - Cuffitis Severity and Quality of Life After Ileal Pouch-Anal Anastomosis: A Retrospective Single-Center Study

ePoster Presenter(s)

• TR

  Timothy J. Ring, Jr., n/a

  Medical Student
  Cleveland Clinic Lerner College of Medicine
  Cleveland Heights, Ohio, United States

  Disclosure information not submitted.

Author(s)

• JP

  Joseph Carter Powers, MD, MS

  Internal Medicine Resident Physician
  University of Michigan
  Ann Arbor, Michigan, United States

  Disclosure information not submitted.
• 

  Arielle E. Kanters, MD, MS

  Colorectal Surgeoin
  Cleveland Clinic
  Cleveland, Ohio, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Stefan D. Holubar, MD, MS, FACS, FASCRS

  Professor of Surgery; Director of Research
  Cleveland Clinic
  Case Western Reserve University
  Cleveland, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.
• SO

  Seo Yoon (Eli) Oh, BA

  Medical Student
  Cleveland Clinic Lerner College of Medicine
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• TQ

  Taha Qazi, MD

  Clinical Assistant Professor
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Scott R. Steele, MD, MBA (he/him/his)

  President, Cleveland Clinic, Main Campus Submarket and Rupert B. Turnbull M.D., Endowed Chair in Colorectal Surgery
  Cleveland Clinic
  Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
  Cleveland, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  David Liska, MD

  Associate Professor, Chair
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland Clinic, Cleveland, Ohio
  Cleveland, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.

Senior Author(s)

• OL

  Olga Lavryk, MD, PhD

  Staff, IBD Surgery Section
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.

Purpose/Background: Cuffitis, an inflammation of the rectal cuff following ileal pouch-anal anastomosis (IPAA), affects 10-30% of IPAA patients. The impact of cuffitis on IPAA outcomes and quality of life (QoL) remains underexplored. The aim of this study was to analyze the relationship between cuffitis, IPAA outcomes, and QoL. We hypothesized that cuffitis negatively affects long-term outcomes and QoL

Methods/Interventions: We identified ileal pouch patients from our institutional pouch registry (2010-2022) who underwent pouchoscopy with colorectal surgery and had documented cuffitis. Cuffitis severity was classified as mild, moderate, or severe at the time of endoscopy. Demographics, postoperative outcomes, and QoL were evaluated in relation to cuffitis severity with univariable analyses. Patients received pouch surveys including the Cleveland Global Quality of Life questionnaire (CGQoLQ), which assesses pouch function and QoL metrics including satisfaction with surgery and restrictions. Multivariable linear regressions were conducted on CGQoL scores to adjust for concomitant pouch inflammation.

Results/Outcomes: Of the 199 cuffitis patients, 121 (61%) patients had mild, 47 (24%) moderate, and 31 (16%) severe inflammation. Patients were comparable in terms of age, sex, BMI, diagnosis, surgical indication, disease duration, and pouch construction (Table 1). Patients in the severe cuffitis group were more likely to have concomitant pouch inflammation compared to the mild and moderate groups: 26 (84%) vs. 68 (56%) and 24 (51%), respectively; p=0.008. Compared to the moderate and severe cuffitis groups, patients with mild cuffitis had a lower incidence of pouch fistulas: 7 (15%) vs. 4 (13%) vs. 10 (8%), respectively; p=0.004. Cuff ulcerations or mucosal breaks were more common in severe and moderate cuffitis compared to mild cases: 14 (45%) vs. 25 (53%) vs. 30 (25%), respectively, p< 0.001. IPAA strictures were most common among patients with mild cuffitis compared to those with moderate and severe inflammation: 18 (15%) vs. 3 (6%) vs. 0 (0%); p=0.03. Pouch failure was comparable between groups.

Among the 79 (39.7%) cuffitis patients who responded to the CGQoLQ, 57 (72%) had mild cuffitis, 16 (20%) had moderate, and 6 (8%) had severe cuffitis, with comparable demographic and clinical characteristics between groups. Responses were assessed at the most recent follow-up: median 7.2 (IQR: 3.1-15.2) years. Severe cuffitis patients had more frequent daytime bowel movements, lower satisfaction with surgery, and less desire to undergo surgery again. Rates of dietary, occupational, social, and sexual restrictions were similar across severity groups (Table 2). In multivariable linear regression models adjusting for concomitant pouch inflammation, neither the presence of cuff ulcerations (β= -0.06, p=0.24) nor cuffitis severity (moderate: β= -0.08, p= 0.15; severe: β= -0.08, p=0.33) were significantly associated with QoL scores. Pouch inflammation was not a significant predictor in either model.

Conclusion/Discussion: Among IPAA patients with cuffitis, severe inflammation, particularly in the presence of ulcerations, was associated with worse patient satisfaction, more frequent daytime bowel movements, and reduced willingness to undergo or recommend surgery. While overall QoL scores did not significantly differ by cuffitis severity, these findings underscore the knowledge gap in understanding and managing postoperative outcomes.

Table 1
Demographic Characteristics and Postoperative Outcomes among Cuffitis Patients (n=199)
Table 2
QOL Measures by Cuffitis Severity for Individuals with QOL Assessments (n=79)