IDDF2021-ABS-0105 Prevalence of ‘pouch failure’ of the ileoanal pouch in ulcerative colitis: a systematic review and meta-analysis

Background The Ileoanal pouch (IPAA) provides patients with ulcerative colitis (UC) that has not responded to medical therapy an option to retain bowel continuity and defecate without the need for a long-term stoma. Despite good functional outcomes, some pouches fail, requiring permanent diversion, pouchectomy or a redo pouch. The incidence of pouch failure ranges between 1% -15% in the literature. Understanding the incidence of pouch failure is vital in counselling patients considering this operation. Therefore, we conducted a systematic review and meta-analysis aiming to define the prevalence of pouch failure in patients with UC who have undergone IPAA using population-based studies. Methods We searched Embase, Embase classic and PubMed from 1978- 31st of May 2021 to identify cross-sectional studies that reported the prevalence of pouch failure in adults (≥18 years of age) who underwent IPAA for UC. We hand-searched the references from eligible studies and the proceedings from Inflammatory bowel disease conferences. We combined the proportion of patients with pouch failure in each study to give a pooled prevalence for each study. We performed a random-effects model in order to pool the data to provide an estimate of the prevalence of pouch failure. Heterogeneity was assessed using the I2 statistic. Results Thirty-three studies comprising 29,153 patients were analysed. After a five-year follow-up period, the prevalence of pouch failure was 4% (95%CI 2%-6%) (IDDF2021-ABS-0105 Figure 1). Between 5-10 years of follow-up, the prevalence was 4% (95%CI 3%-7%) (IDDF2021-ABS-0105 Figure 2). This increased to 11% (95%CI 7%-16%) with over 10 years of follow-up (IDDF2021-ABS-0105 Figure 3). The overall prevalence of pouch failure was 5% (95%CI 4%-6%) (IDDF2021-ABS-0105 Figure 4). Conclusions The prevalence of pouch failure in patients over the age of 18 who have undergone restorative proctocolectomy in UC is 11% after a 10-year follow-up. These data are important for counselling patients considering this operation. Importantly, for those patients with UC being considered for a pouch, their disease course has often resulted in both physical and psychological morbidity and hence providing accurate expectations for these patients is vital.