{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T02:07:03Z","timestamp":1790474823160,"version":"4.1.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2020,1,8]],"date-time":"2020-01-08T00:00:00Z","timestamp":1578441600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,30]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Indeterminate colitis [IC] is type of inflammatory bowel disease that exhibits features of both ulcerative colitis [UC] and Crohn\u2019s disease [CD]. The present meta-analysis aimed to assess the outcomes of ileal pouch-anal anastomosis [IPAA] in patients with IC in comparison with patients with UC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A PRISMA-compliant systematic review of the outcome of IPAA in patients with IC was conducted. Electronic databases were searched, and full-text articles were reviewed to extract essential data. Main outcome measures were pouch failure and pouch-related complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 17 studies were included in this meta-analysis. There were 1057 patients with IC and 6511 patients with UC. The weighted mean pouch failure rate in patients with IC was 7.5 (95% confidence interval [CI]: 4.8\u201310.2) and the weighted mean complication rate was 67 [95% CI: 53.5\u201380.5]. As compared with patients with UC, patients with IC had significantly higher odds of developing complications after IPAA (odds ratio [OR]: 2.6, p\u2005&amp;lt;0.001): pouch fistula [OR:4.98, p\u2005&amp;lt;0.001], pelvic sepsis [OR:3.98, p\u2005=0.002], pelvic or cuff abscess [OR: 4.5, p\u2005&amp;lt;0.001], perineal complications [OR: 5.13, p\u2005&amp;lt;0.001], and ultimate diagnosis of CD [OR: 2.57, p\u2005&amp;lt;0.001]. Patients with IC and UC had similar odds of pouch failure, pouchitis, anastomotic leak, stricture, and small bowel obstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with IC had similar pouch failure rates, yet higher overall complication rates than patients with UC. Complications that tend to be higher after IPAA for patients with IC include pouch fistula, pelvic sepsis, abscess, perineal complications, and ultimate diagnosis of Crohn\u2019s disease.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ecco-jcc\/jjaa002","type":"journal-article","created":{"date-parts":[[2020,1,3]],"date-time":"2020-01-03T20:20:02Z","timestamp":1578082802000},"page":"1010-1020","source":"Crossref","is-referenced-by-count":19,"title":["Outcome of Ileal Pouch-anal Anastomosis in Patients With Indeterminate Colitis: A Systematic Review and Meta-analysis"],"prefix":"10.1093","volume":"14","author":[{"given":"Sameh Hany","family":"Emile","sequence":"first","affiliation":[{"name":"Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayim","family":"Gilshtein","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8046-5753","authenticated-orcid":false,"given":"Steven D","family":"Wexner","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,1,8]]},"reference":[{"key":"2020073012070653700_CIT0001","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1016\/S0140-6736(17)32448-0","article-title":"Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies","volume":"390","author":"Ng","year":"2018","journal-title":"Lancet"},{"key":"2020073012070653700_CIT0002","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.cgh.2016.10.039","article-title":"Incidence and prevalence of Crohn\u2019s disease and ulcerative colitis in Olmsted County, Minnesota from 1970 through 2010","volume":"15","author":"Shivashankar","year":"2017","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2020073012070653700_CIT0003","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/00042737-200606000-00005","article-title":"Increase in incidence and prevalence of inflammatory bowel disease in northern Denmark: a population-based study, 1978\u20132002","volume":"18","author":"Jacobsen","year":"2006","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"2020073012070653700_CIT0004","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.3109\/00365521.2014.962605","article-title":"Prevalence of inflammatory bowel disease: estimates for 2010 and trends in Germany from a large insurance-based regional cohort","volume":"49","author":"Hein","year":"2014","journal-title":"Scand J Gastroenterol"},{"key":"2020073012070653700_CIT0005","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/apt.12528","article-title":"Nationwide prevalence of inflammatory bowel disease in Sweden: a population-based register study","volume":"39","author":"B\u00fcsch","year":"2014","journal-title":"Aliment Pharmacol Ther"},{"key":"2020073012070653700_CIT0006","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1038\/nrgastro.2015.150","article-title":"The global burden of IBD: from 2015 to 2025","volume":"12","author":"Kaplan","year":"2015","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"2020073012070653700_CIT0007","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1053\/j.gastro.2016.10.020","article-title":"Understanding and preventing the global increase of inflammatory bowel disease","volume":"152","author":"Kaplan","year":"2017","journal-title":"Gastroenterology"},{"key":"2020073012070653700_CIT0008","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1136\/jcp.31.6.567","article-title":"Overlap in the spectrum of non-specific inflammatory bowel disease \u2013 \u2018colitis indeterminate\u2019","volume":"31","author":"Price","year":"1978","journal-title":"J Clin Pathol"},{"key":"2020073012070653700_CIT0009","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1136\/gut.2005.082909","article-title":"The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications","volume":"55","author":"Satsangi","year":"2006","journal-title":"Gut"},{"key":"2020073012070653700_CIT0010","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.crohns.2009.07.001","article-title":"Frequency of indeterminate colitis in children and adults with IBD\u2014a meta-analysis","volume":"3","author":"Prenzel","year":"2009","journal-title":"J Crohns Colitis"},{"key":"2020073012070653700_CIT0011","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1007\/s10350-004-6461-0","article-title":"Indeterminate colitis: the real story","volume":"45","author":"Rudolph","year":"2002","journal-title":"Dis Colon Rectum"},{"key":"2020073012070653700_CIT0012","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/BF02050413","article-title":"Evolutionary changes in the pathologic diagnosis after the ileoanal pouch procedure","volume":"40","author":"Marcello","year":"1997","journal-title":"Dis Colon Rectum"},{"key":"2020073012070653700_CIT0013","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1007\/BF02236726","article-title":"Ileal pouch-anal anastomosis in patients with indeterminate colitis: long-term results","volume":"43","author":"Yu","year":"2000","journal-title":"Dis Colon Rectum"},{"key":"2020073012070653700_CIT0014","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.surg.2017.11.014","article-title":"Long-term outcomes following ileal pouch-anal anastomosis in patients with indeterminate colitis","volume":"163","author":"Netz","year":"2018","journal-title":"Surgery"},{"key":"2020073012070653700_CIT0015","doi-asserted-by":"crossref","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"2020073012070653700_CIT0016","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1046\/j.1445-2197.2003.02748.x","article-title":"Methodological index for non-randomized studies [MINORS]: development and validation of a new instrument","volume":"73","author":"Slim","year":"2003","journal-title":"ANZ J Surg"},{"key":"2020073012070653700_CIT0017","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1007\/DCR.0b013e31819f5d4c","article-title":"A prospective evaluation of the long-term outcome of ileal pouch-anal anastomosis in patients with inflammatory bowel disease-unclassified and indeterminate colitis","volume":"52","author":"Murrell","year":"2009","journal-title":"Dis Colon Rectum"},{"key":"2020073012070653700_CIT0018","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1111\/j.1463-1318.2005.00800.x","article-title":"Long-term outcomes of restorative proctocolectomy for Crohn\u2019s disease and indeterminate colitis","volume":"7","author":"Tekkis","year":"2005","journal-title":"Colorectal Dis"},{"key":"2020073012070653700_CIT0019","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1007\/s10350-003-0116-4","article-title":"Outcome of patients with indeterminate colitis undergoing a double-stapled ileal pouch-anal anastomosis","volume":"47","author":"Pishori","year":"2004","journal-title":"Dis Colon Rectum"},{"key":"2020073012070653700_CIT0020","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1053\/jpsu.2003.50015","article-title":"Fate of the pouch in 151 pediatric patients after ileal pouch-anal anastomosis","volume":"38","author":"Alexander","year":"2003","journal-title":"J Pediatr Surg"},{"key":"2020073012070653700_CIT0021","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1007\/s11605-016-3306-9","article-title":"Long-term outcomes in indeterminate colitis patients undergoing ileal pouch-anal anastomosis: function, quality of life, and complications","volume":"21","author":"Jackson","year":"2017","journal-title":"J Gastrointest Surg"},{"key":"2020073012070653700_CIT0022","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1007\/s10350-005-0059-z","article-title":"Crohn\u2019s disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure","volume":"48","author":"Brown","year":"2005","journal-title":"Dis Colon Rectum"},{"key":"2020073012070653700_CIT0023","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1007\/s10350-005-0013-0","article-title":"Serologic responses in indeterminate colitis patients before ileal pouch-anal anastomosis may determine those at risk for continuous pouch inflammation","volume":"48","author":"Hui","year":"2005","journal-title":"Dis Colon Rectum"},{"key":"2020073012070653700_CIT0024","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1046\/j.1463-1318.2003.00449.x","article-title":"Pathological subgroups may predict complications but not late failure after ileal pouch-anal anastomosis for indeterminate colitis","volume":"5","author":"Gramlich","year":"2003","journal-title":"Colorectal Dis"},{"key":"2020073012070653700_CIT0025","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/00000658-200207000-00008","article-title":"Equivalent function, quality of life and pouch survival rates after ileal pouch-anal anastomosis for indeterminate and ulcerative colitis","volume":"236","author":"Delaney","year":"2002","journal-title":"Ann Surg"},{"key":"2020073012070653700_CIT0026","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1001\/archsurg.137.6.690","article-title":"Similar functional results and complications after ileal pouch-anal anastomosis in patients with indeterminate vs ulcerative colitis","volume":"137","author":"Dayton","year":"2002","journal-title":"Arch Surg"},{"key":"2020073012070653700_CIT0027","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/BF02053857","article-title":"Indeterminate colitis. Long-term outcome in patients after ileal pouch-anal anastomosis","volume":"38","author":"McIntyre","year":"1995","journal-title":"Dis Colon Rectum"},{"key":"2020073012070653700_CIT0028","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/0002-9610(94)90248-8","article-title":"Restorative proctocolectomy and indeterminate colitis","volume":"167","author":"Atkinson","year":"1994","journal-title":"Am J Surg"},{"key":"2020073012070653700_CIT0029","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1007\/BF02049696","article-title":"Indeterminate colitis predisposes to perineal complications after ileal pouch-anal anastomosis","volume":"34","author":"Koltun","year":"1991","journal-title":"Dis Colon Rectum"},{"key":"2020073012070653700_CIT0030","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1136\/jcp.2003.015214","article-title":"Indeterminate colitis","volume":"57","author":"Guindi","year":"2004","journal-title":"J Clin Pathol"},{"key":"2020073012070653700_CIT0031","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/j.1365-2559.2006.02545.x","article-title":"Indeterminate colitis: definition, diagnosis, implications and a plea for nosological sanity","volume":"50","author":"Martland","year":"2007","journal-title":"Histopathology"},{"key":"2020073012070653700_CIT0032","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1111\/codi.12614","article-title":"The extent of inflammation is a predictor for pouch-related complications in ileal pouches in patients with ulcerative or indeterminate colitis","volume":"16","author":"Tan","year":"2014","journal-title":"Colorectal Dis"},{"key":"2020073012070653700_CIT0033","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1093\/ecco-jcc\/jjv066","article-title":"Outcomes of salvage surgery for ileal pouch complications and dysfunctions. The experience of a referral centre and review of literature","volume":"9","author":"Pellino","year":"2015","journal-title":"J Crohns Colitis"},{"key":"2020073012070653700_CIT0034","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1177\/000313481608201026","article-title":"De novo Crohn\u2019s disease after ileal pouch-anal anastomosis for ulcerative colitis and inflammatory bowel disease unclassified: long-term follow-up of a prospective inflammatory bowel disease registry","volume":"82","author":"Zaghiyan","year":"2016","journal-title":"Am Surg"},{"key":"2020073012070653700_CIT0035","doi-asserted-by":"crossref","first-page":"39","DOI":"10.2147\/CEG.S108513","article-title":"Perianal Crohn\u2019s disease: challenges and solutions","volume":"10","author":"Kelley","year":"2017","journal-title":"Clin Exp Gastroenterol"}],"container-title":["Journal of Crohn's and Colitis"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ecco-jcc\/advance-article-pdf\/doi\/10.1093\/ecco-jcc\/jjaa002\/31899483\/jjaa002.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ecco-jcc\/article-pdf\/14\/7\/1010\/33550680\/jjaa002.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ecco-jcc\/article-pdf\/14\/7\/1010\/33550680\/jjaa002.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,15]],"date-time":"2021-02-15T02:33:21Z","timestamp":1613356401000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ecco-jcc\/article\/14\/7\/1010\/5698184"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,8]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2020,1,8]]},"published-print":{"date-parts":[[2020,7,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ecco-jcc\/jjaa002","relation":{},"ISSN":["1873-9946","1876-4479"],"issn-type":[{"value":"1873-9946","type":"print"},{"value":"1876-4479","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,7]]},"published":{"date-parts":[[2020,1,8]]}}}