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Total proctocolectomy followed by ileal pouch-anal anastomosis (IPAA) is currently the reference treatment in familial adenomatous polyposis (FAP) and ulcerative colitis (UC). At our institution, we always advocate the realization of an endoanal mucosectomy (EAM) followed by handsewn anastomosis at the level of the dentate line while other centers prefer a double-stapled anastomosis, invoking the superiority of this technique without EAM on functional results. The purpose of the present study is to evaluate the relevance of EAM considering functional results as well as control of neoplastic risk for patients treated at our institution since 1986.Methods. Medical records of 166 consecutive patients treated by IPAA for FAP (n = 57) or UC (n = 109) at our institution were reviewed. The data, which were specifically studied, include functional assessments at follow-up consultations, pathology of the EAM and findings made during the endoscopy monitoring of the ileal pouch. Results. The median stool frequency in our series of patients was 5,8 (IQR : 4,7-7,6) per 24h and 1,0 at n1ghttime (IQR : 0,5-1,8). 82% of patients had perfect daytime continence. 57% had perfect nighttime continence and 23% had less than one nighttime leakage per week. 76% of patients had less than one episode of urgency per week and 54% did not suffer from urgency at all. In patients with FAP, we found dysplasia or cancer on 73% of EAM specimens (94% of LGD, one in situ carcinoma and one invasive carcinoma). ln UC patients, only one EAM specimen showed LGD. None of our patients with FAP or RCUH was found to develop cancer in his pouch or anal canal after a median follow-up of 86 months (IQR :55-138) and 60 months (IQR : 25-102) respectively. ln patients with UC, endoscopy monitoring did not show any arousal of adenomas in the pouch. ln patients with FAP, 43% developed LGD after a median follow-up of 86 months (IQR : 60-128) and one patient (2,1%) showed HGD after 216 months of follow-up. Conclusions. Although we systematically perform an EAM in our patients, our functional results are as satisfying as the references we find in the literature, except with regards to nocturnal continence. However, the majority of patients who notice such an alteration do not mention more than one leakage per week. The high prevalence of dysplasia as well as the presence of two carcinomas on specimens from our patients with FAP are major reasons for conducting EAM in those patients. ln patients with RCUH, prevalence of dysplasia is much lower. The findings made during endoscopy monitoring are currently not putting any discredit on the efficiency of our EAMs. However, one should continue to perform this monitoring in order to keep an eye on the two distinct issues, which are the development of pouch dysplasia and the emergence of cancer on an islet of residual colonic mucosa. An influence of BMI on the development of adenomas in the ileal pouch was brought out and deserves further investigation. La coloproctectomie totale (CPT) suivie d'une anastomose iléo-anale (AIA) sur réservoir iléal est actuellement le traitement de référence de la polypose adénomateuse familiale (PAF) et de la rectocolite hémorragique (RCUH). Aux Cliniques universitaires Saint-Luc (CUSL), nous préconisons toujours la réalisation d'une mucosectomie endo-anale (MEA) suivie d'une anastomose manuelle à la ligne pectinée tandis que d’autres centres privilégient une anastomose mécanique à l’agrafeuse circulaire en invoquant une supériorité de cette technique sans MEA sur les résultats fonctionnels. L'objectif de cette étude est d'évaluer la pertinence de la MEA en mettant en balance les résultats fonctionnels et le contrôle du risque néoplasique chez les patients opérés aux CUSL depuis 1986. Méthode. Les dossiers médicaux de 166 patients consécutifs ayant bénéficié d'une CPT avec AIA manuelle pour PAF (n = 57) ou RCUH (n = 109) aux CUSL ont été passés en revue. Les données extraites comprenaient les évaluations fonctionnelles faites aux consultations de suivi, les résultats de l'analyse anatomo-pathologique de la pièce de MEA et les découvertes faites au cours de la surveillance endoscopique du réservoir iléal. Résultats. La médiane du nombre de selles dans notre série s'élève à 5,8 par 24h (El : 4,7-7,6) et à 1,0 par nuit (El: 0,5-1,8). 82% de nos patients présentent une continence diurne parfaite. 57% ont une continence parfaite la nuit et 23% présentent moins d'une fuite nocturne par semaine. 76% de nos patients ont moins d'un épisode d'impériosité par semaine et 54% n'en présentent jamais. 73% des MEA des patients opérés pour PAF montraient la présence de dysplasie ou de cancer (94% de DBG, un carcinome in situ et un carcinome invasif). Chez les patients opérés pour RCUH, une seule pièce de MEA (1,3%) contenait de la DBG. Aucun de nos patients opérés pour PAF ou RCUH n'a développé de cancer dans le réservoir ou le canal anal après des surveillances n'a pas non plus mis en évidence de polype dysplasique. Dans la PAF, 43% des patients ont développé de la DBG après un délai médian de 86 mois (El :60-128) et un patient (2,1%) a développé de la DHG 216 mois après I’AIA. Conclusions. Malgré la réalisation systématique d'une MEA chez nos patients, nos résultats fonctionnels sont aussi satisfaisants que les références trouvées dans littérature sauf en ce qui concerne la continence nocturne. Cependant, la majorité des patients signalant une altération de celle-ci ne présentent pas plus d'un épisode de fuite par semaine. L'importante prévalence de dysplasie et la présence de deux carcinomes sur les pièces de MEA de nos patients opérés pour PAF sont des arguments majeurs en faveur de sa réalisation. Dans la RCUH, la dysplasie est beaucoup plus rare. La surveillance endoscopique ne met pas en doute l'efficacité de nos MEA à l'heure actuelle. Il convient de poursuivre cette surveillance afin de garder un œil sur le développement de dysplasie dans le réservoir et l'apparition de cancer sur un ilot de muqueuse colique résiduelle. Une influence du BMI sur le développement de polypes dans le réservoir a été mise en évidence et mériterait investigation.

Proctocolectomy, Restorative --- Colitis, Ulcerative --- Adenomatous Polyposis Coli

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Intestinal polyps --- Intestines --- Intestins --- Diseases --- Polypes --- Maladies --- Adenomatous Polyposis Coli --- Intestina Polyposis

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The initial identification of the Adenomatous polyposis coli (Apc) gene as the site of mutations in familial adenomatous polyposis (FA P) was described in 1992. A causal relationship between Apc mutations and intestinal tract tumours was confirmed three years later with the establishment of the Min mouse model. These mice are heterozygous for Apc and develop numerous intestinal tumours that mimic FA P. Subsequently, Apc has emerged as the most commonly mutated gene in colorectal cancer with reports varying between 50-80 per cent of sporadic tumours carrying such mutations. The search for how m

Adenomatous Polyposis Coli Protein. --- Adenomatous Polyposis Coli. --- Colon (Anatomy) -- Cancer. --- Colorectal Neoplasms -- Metabolism. --- Genes, APC. --- Tumor suppressor proteins. --- Colon (Anatomy) --- Tumor suppressor proteins --- Adenomatous Polyposis Coli --- Colorectal Neoplasms --- Genes, APC --- Metabolism --- Adenomatous Polyposis Coli Protein --- Intestinal Polyposis --- Intestinal Neoplasms --- Colonic Neoplasms --- Neoplastic Syndromes, Hereditary --- Colonic Diseases --- Metabolic Phenomena --- Cytoskeletal Proteins --- Genes, Tumor Suppressor --- Tumor Suppressor Proteins --- Rectal Diseases --- Adenomatous Polyps --- Proteins --- Neoplasm Proteins --- Intestinal Diseases --- Neoplasms --- Genes, Neoplasm --- Phenomena and Processes --- Gastrointestinal Neoplasms --- Genes, Recessive --- Adenoma --- Genetic Diseases, Inborn --- Gastrointestinal Diseases --- Digestive System Neoplasms --- Genes --- Diseases --- Neoplasms, Glandular and Epithelial --- Congenital, Hereditary, and Neonatal Diseases and Abnormalities --- Amino Acids, Peptides, and Proteins --- Chemicals and Drugs --- Digestive System Diseases --- Genome Components --- Neoplasms by Site --- Neoplasms by Histologic Type --- Genome --- Genetic Structures --- Genetic Phenomena --- Oncology --- Medicine --- Health & Biological Sciences --- Cancer --- Cancer. --- Antioncoproteins --- Growth suppressor proteins --- Metastasis suppressor proteins --- Colon cancer --- Colorectal cancer --- Medicine. --- Biomedicine. --- Biomedicine general. --- Clinical sciences --- Medical profession --- Human biology --- Life sciences --- Medical sciences --- Pathology --- Physicians --- Antioncogenes --- Health Workforce --- Biomedicine, general.

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Colorectal Neoplasms, Hereditary Nonpolyposis --- Duodenal Neoplasms --- Colectomy --- Adenomatous Polyposis Coli --- Decision Support Techniques. --- Analysis, Decision --- Clinical Prediction Rule --- Decision Aids --- Decision Support Technics --- Decision Analysis --- Decision Modeling --- Models, Decision Support --- Aid, Decision --- Aids, Decision --- Analyses, Decision --- Clinical Prediction Rules --- Decision Aid --- Decision Analyses --- Decision Support Model --- Decision Support Models --- Decision Support Technic --- Decision Support Technique --- Model, Decision Support --- Modeling, Decision --- Prediction Rule, Clinical --- Prediction Rules, Clinical --- Rule, Clinical Prediction --- Rules, Clinical Prediction --- Technic, Decision Support --- Technics, Decision Support --- Technique, Decision Support --- Techniques, Decision Support --- Clinical Decision-Making --- Decision Making --- Decision Making, Organizational --- drug therapy. --- surgery. --- mortality. --- complications. --- Theses --- 681.3*D3 --- 681.3*D3 Programming languages --- Programming languages --- Decision Support Techniques --- drug therapy --- surgery --- mortality --- complications