Long-term histomorphological surveillance of the pelvic ileal pouch: dysplasia develops in a subgroup of patients

Gastroenterology. 1995 Oct;109(4):1090-7. doi: 10.1016/0016-5085(95)90566-9.


Background & aims: Little is known about the long-term morphology of the pelvic ileal pouch after restorative proctocolectomy in patients with ulcerative colitis. This study analyzed the mucosal adaptation in the pouch during a long-term follow-up.

Methods: Mucosal biopsy specimens were obtained from 87 patients during a follow-up of 6.3 years (SD, 2.7; range, 3-14 years). The villous surface density, degree of inflammation, and type of mucin were determined from glycolmethacrylate-embedded sections.

Results: Three basic patterns of mucosal adaptation were observed: regular response with normal mucosa or mild villous atrophy and no or mild inflammation (type A, 51%), transient atrophy response with temporary moderate or severe villous atrophy followed by normalization of architecture (type B, 40%), and constant atrophy response with permanent subtotal or total villous atrophy developing from the early functioning period accompanied by severe pouchitis (type C, 9%). Low-grade dysplasia occurred in 3 patients with type C response.

Conclusions: In a small group of patients with ulcerative colitis, the mucosa of the pelvic pouch adapts with constant severe villous atrophy accompanied by long-standing pouchitis. This group of patients should be identified and undergo regular endoscopic and histomorphological surveillance because of risk of developing neoplasia in the pouch mucosa.

MeSH terms

  • Adult
  • Atrophy
  • Colitis, Ulcerative / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Intestinal Mucosa / pathology*
  • Male
  • Mucins / analysis
  • Postoperative Complications / pathology
  • Precancerous Conditions / pathology
  • Proctocolectomy, Restorative*


  • Mucins