Colectomy for patients with ulcerative colitis and primary sclerosing cholangitis - What next?

Background and aims Primary sclerosing cholangitis (PSC) occurs in 2%-8% of patients who suffer from ulcerative colitis (UC). For patients who require colectomy, ileal pouch-anal anastomosis (IPAA) or ileorectal anastomosis (IRA) is employed to preserve continence.We evaluated the outcomes after IPAA and IRA for patients with UC-PSC, using patients with UC but without PSC as controls (UC-only group). Patients In a case-control study conducted at Sahlgrenska University Hospital, Sweden, patients with UC-PSC (N = 48; 31 IPAA and 17 IRA) were compared to patients with UC only (N = 113; 62 IPAA and 51 IRA). Functional outcomes (oresland score), pouchitis, surgical complications, and failure were evaluated. Results For patients with IPAA, the median oresland scores were similar for the two groups: 5 (range, 0-13) for the UC-PSC group and 5 for the UC-only group (range, 0-12; p > 0.05). However, the IRA scores were significantly different at 7 (range, 2-11) and 3 (range, 0-11) for the respective groups (p = 0.005). Pouchitis was more frequent in patients with UC-PSC. Complication rates did not differ. For patients with IPAA, the failure rate was 16% for those in the UC-PSC group versus 6% for those in the UC-only group (p > 0.05); the corresponding results for IRA were 53% versus 22% (p = 0.03). Conclusions For cases of IPAA, pouchitis seems to be more common in patients with UC-PSC. However, the functional outcomes and failure rates are unaffected by concurrent PSC. For patients with UC-PSC, functional outcome is poor and the failure rate is high after IRA.