News Prevalence of ‘pouch failure’ of the ileoanal pouch in ulcerative colitis: a systematic review and meta‑analysis
The International Journal of Colorectal disease recently published a paper “Prevalence of ‘pouch failure’ of the ileoanal pouch in ulcerative colitis: a systematic review and meta‑analysis” by Zaid Alsafi, Alice Snell and Jonathan P. Segal which is an important study into the subject. Below, RLG chairman, David Davies reviews the paper. You can download the full paper at the end of this article.
How long do pouches last?
One of the important questions for pouchees is how long is their pouch likely to last? It is a regular question during webinars, during the zoom pouch forums and on the J-pouch support Facebook group at RLG and reflects a general concern that pouches will deteriorate over time. There are lots of references to pouch failure rates in medical publications – the generally accepted wisdom is 10-11% and publications from all over the world quote 2-15%, depending on many variables. No one knows for sure how many pouch surgeries have been carried out, which makes it difficult to estimate the failure rate.
Another way to estimate pouch failure rate is to look at the published medico-scientific literature from clinical trials, where extensive data is meticulously collected. But most single clinical trials are not very big, tend to involve a small, localised population and are not necessarily representative of the wider situation.
Medical researchers from Imperial College, London, have recently gathered together the data on pouch failure from a number of similar studies. In a paper published in the prestigious International Journal of Colorectal Disease the researchers’ collected data from many clinical trials and analysed it through a “meta-analysis”. Care has to be taken with meta-analyses to ensure that the data from many different sources can be summed up and analysed together but, if so, then the conclusions are likely to be more robust than from individual studies because the numbers involved are much larger. The investigators specifically focussed on adults (aged at least 18 years) and who had their surgeries due to ulcerative colitis. Pouchees will be reassured to hear the estimates of pouch failure rate from this meta-analysis were surprisingly low.
The researchers included data from 26 clinical trials conducted between 1978 to 2021, presumably including countries outside the UK. These studies involved 23,389 people and therefore present a huge amount of data for definitive calculation of pouch longevity.
The results of the meta-analysis are dramatic, as follows:
| Description | Mean failure rate (%) | * Range (%) |
|---|---|---|
| Pouches less than 5 years old | 5 | 3-10 |
| Pouches between 5 and 10 years old | 5 | 4-7 |
| Pouches greater than 10 years old | 9 | 7-16 |
| Overall average pouch failure rate | 6 | 5-8 |
*95% confidence limits (i.e. 95% of the data points occurred within this range)
In other words, for pouches less than 5 years old the mean failure rate was only 5% (with the range 3-10%). For pouches aged between 5 and 10 year the mean failure rate was also 5% but with a narrower range (4-7%). For pouches greater than 10 years old the mean failure rate was 9% (range 7-16%). And the overall prevalence of pouch failure was 6% (and within the range 5-8% for 95% of the patients followed).
The results suggest that previous estimates were on the high side and that pouch failures occur at approximately 6% in adults who had their surgery for ulcerative colitis. The researchers conclude “The overall prevalence of pouch failure in patients over the age of 18 who have undergone restorative proctocolectomy in UC is 6%. These data are important for counselling patients considering this operation”. Indeed it is an important consideration for people contemplating the pouch operation.
Hopefully this sort of analysis will provide definitive and reliable data to inform people who are trying to decide between a pouch and a permanent ileostomy.
David Davies
Chair – Red Lion Group
You can download the full paper below.
