pouchoscopy

Pouchoscopy is the endoscopic examination of an ileal pouch-anal anastomosis (IPAA) and the surrounding anal transitional zone. It is performed in people who have undergone proctocolectomy, most commonly for ulcerative colitis or familial adenomatous polyposis, to assess pouch function, mucosal health, and anastomotic integrity.

Indications include routine surveillance after IPAA, evaluation of symptoms such as increased stool frequency, urgency, abdominal pain, rectal bleeding, or fever, and assessment of pouchitis, cuffitis, Crohn’s disease involving the pouch, stenosis, polyps, or other pouch-related complications. Endoscopic findings help guide further management.

Technique typically involves introducing a flexible endoscope through the anus into the ileal pouch and examining the pouch mucosa, the anastomotic cuff, and the afferent limb. Insufflation is kept cautious to avoid overdistention, and water irrigation may be used to improve visualization. The procedure may include taking mucosal biopsies for histology. Sedation ranges from none to light or moderate, depending on patient and local practice, and may be performed with or without monitored anesthesia care.

Findings are interpreted in conjunction with clinical symptoms and, when relevant, scoring systems such as the pouchitis disease activity index. Management is guided by the underlying condition; pouchitis often responds to antibiotics, while Crohn’s disease in the pouch may require alternative therapies. Biopsies help distinguish inflammatory conditions from infection or neoplasia.

Risks are relatively low but include bleeding, perforation, infection, and adverse reactions to sedation. Limitations include patient discomfort and occasionally limited visualization in complex anatomy. Pouchoscopy is a key tool in the long-term care of IPAA patients.