P1160 - Post-Operative Pelvic Floor Dysfunction on Anorectal Manometry Is Associated With Pouch Ulceration After Ileal Pouch-Anal Anastomosis

Award: ACG Presidential Poster Award

Emma Dester, BS, MS¹, Joseph Carter Powers, MS, MD², Riley Smith, DO³, Katherine Westbrook Cates, DO⁴, Mark Zemanek, DO⁵, Zeeyong Kwong, BS¹, Anna Spivak, DO⁶, Benjamin L. Cohen, MD⁵, Katherine Falloon, MD⁵, Tracy Hull, MD⁶, Taha Qazi, MD⁵
1Cleveland Clinic Lerner College of Medicine, Cleveland, OH; 2University of Michigan, Cleveland, OH; 3Cleveland Clinic, Beachwood, OH; 4Louisiana State University, New Orleans, LA; 5Cleveland Clinic Foundation, Cleveland, OH; 6Cleveland Clinic, Cleveland, OH

Introduction: Anorectal manometry (ARM) is commonly performed in patients with inflammatory bowel disease (IBD) undergoing an ileal pouch-anal anastomosis (IPAA). We previously demonstrated patients with abnormal sphincter function on pre-operative ARM have a higher prevalence of pouch ulceration (p=0.016), rectal cuff inflammation (p=0.001), and pouch excision (p=0.019). For the present study, we hypothesize post-operative ARM (conducted after completion of surgical series) will similarly be predictive of inflammatory outcomes and pouch failure.

Methods: This single-center retrospective study examined IBD patients with IPAA who underwent post-operative ARM at Cleveland Clinic between 2009 and 2024 with at least one pouchoscopy > 6 months after ileostomy takedown. Patients < 18 years old at time of colectomy and patients with ostomies at the time of ARM were excluded. Patients were divided into two groups, one for patients with normal relaxation of the anal sphincter with strain (normal function) and the other for those with failure to relax with strain (abnormal function). The primary outcome was post-operative inflammation of the pouch and/or rectal cuff.

Results: A total of 123 patients were included: 51 patients in the abnormal function group and 72 patients in the normal function group. The groups were similar in demographic and pre-operative variables except for age and gender, with the abnormal function group favoring female gender (p< 0.001) and younger age (p=0.037). There was no significant difference in follow-up time, time to post-operative ARM, or post-operative symptoms prior to ARM (including incontinence and incomplete evacuation). In univariate analysis, the abnormal function group had a higher prevalence of rectal cuff inflammation (p=0.037; Table 1) and pouch excision (p=0.016; Table 1). Multivariable logistic regression showed a significant association between pouch ulceration and abnormal ARM while adjusting for gender and endoscopic evidence of strictures (p=0.049, Table 2); age did not significantly contribute to the model and thus was substituted with strictures, a significant covariate. Multivariate logistic regression did not show a significant association between cuffitis and abnormal ARM (p=0.071).

Discussion: Post-operative ARM abnormalities are significantly associated with pouch ulceration and may predict long-term inflammatory outcomes in IPAA patients. These findings support the utility of post-operative ARM in the comprehensive assessment of patients with IPAA.


Figure: Table 1. Univariate analysis of endoscopic and surgical outcomes


Figure: Table 2. Multivariable logistic regression for development of ulceration, adjusting for ARM, gender, stricture

Disclosures:
Emma Dester indicated no relevant financial relationships.
Joseph Carter Powers indicated no relevant financial relationships.
Riley Smith indicated no relevant financial relationships.
Katherine Westbrook Cates indicated no relevant financial relationships.
Mark Zemanek indicated no relevant financial relationships.
Zeeyong Kwong indicated no relevant financial relationships.
Anna Spivak: Medtronic – Advisory Committee/Board Member.
Benjamin Cohen: Abbvie – Advisory Committee/Board Member, Consultant, Speakers Bureau. ALPCO – Advisory Committee/Board Member, Consultant. Emmes Biopharma Services LLC – DSMB. J&J Innovative Medicine – Advisory Committee/Board Member. Pfizer – Advisory Committee/Board Member. Takeda – Consultant, Speakers Bureau.
Katherine Falloon: Cardinal Health, Inc. – Husband is employee. Janssen Pharmaceuticals, Inc. – Consultant. MD Education – Speaker. Pfizer – Grant/Research Support. Takeda Pharmaceuticals, Inc. – Speaker.
Tracy Hull indicated no relevant financial relationships.
Taha Qazi: Abbvie – Advisor or Review Panel Member, Advisory Committee/Board Member, Consultant, Grant/Research Support, Speakers Bureau. Celltirion – Grant/Research Support. Eli Lilly – Advisor or Review Panel Member, Advisory Committee/Board Member, Consultant. Johnson and Johnson – Advisor or Review Panel Member, Advisory Committee/Board Member, Consultant, Speakers Bureau. pfizer – Grant/Research Support.

Emma Dester, BS, MS¹, Joseph Carter Powers, MS, MD², Riley Smith, DO³, Katherine Westbrook Cates, DO⁴, Mark Zemanek, DO⁵, Zeeyong Kwong, BS¹, Anna Spivak, DO⁶, Benjamin L. Cohen, MD⁵, Katherine Falloon, MD⁵, Tracy Hull, MD⁶, Taha Qazi, MD⁵. P1160 - Post-Operative Pelvic Floor Dysfunction on Anorectal Manometry Is Associated With Pouch Ulceration After Ileal Pouch-Anal Anastomosis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.