Cristian Gallardo interviewed Caroline Nordenvall, colorectal surgeon Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden, about her ulcerative colitis presentation at this year's conference.
Her research into the surgical treatment of patients with inflammatory bowel disease (IBD) has shown that less than half of patients who have had a colectomy undergo reconstructive surgery, which has resulted in the CRUISE study - a study to prospectively compare two different surgical methods in reconstructive surgery, ileorectal anastomosis and pelvic reservoir, for the first time.
Caroline will speak at the ESCP 15th Annual & Scientific Conference in September, Virtually Vilnius, about the IRA, pouch or Kock's pouch for ulcerative colitis.
Ulcerative colitis (UC) is a relapsing remitting IBD affecting the rectum and colon in a retrograde pattern of inflammation, starting at the rectum. The majority of patients are managed with medical therapy, however, a significant minority will eventually require colectomy. After this, in order to live without a permanent ileostomy following a colectomy, patients may choose to undergo restorative surgery in the form of an ileal pouch, ileorectal anastomosis (IRA) or continent ileostomy. A longstanding disparity exists between the approaches to restorative surgery after colectomy for patients with ulcerative colitis in terms of time, type and rates of restoration between different surgical teams and countries. For example, in the UK the ileal pouch is the most popular restorative option, but in Sweden patients are more likely to receive an IRA after colectomy.
Cristian Gallardo: What is key to know ahead of your talk?
Caroline Nordenvall: Restorative surgery in UC-patients involves young patients and the results of performed (or not performed) reconstructions may have a great impact on their future well-being.
CG: Why do you think there is a disparity in terms of types of restorative surgery between different countries with similar healthcare systems?
CN: I believe that given treatment is still influenced by local traditions and local experiences. We need more research to be able to give our UC-patients evidence-based recommendations regarding the different options, and to reduce present disparities.
CG: In which cases do you think the IRA is the best option?
CN: I believe that IRA is an option for young patients with a mild inflammation in the rectum. However, whether IRA is the best option or not for a specific person needs to be discussed and decided with the patient.
CG: How will your talk differ from normal textbook on IBD surgery - types of restorative surgery?
CN: Personalised medicine is a hot topic in many medical fields, and it is also relevant for this patient group. For patients eligible for IRA and pouch we have the option not to follow an algorithm, but to make the choice of restorative method in collaboration with the patient.
CG: Are there any future developments in the field?
CN: The CRUISE-study is a multicentre preference study running in England and Sweden where patients suitable for both IRA and pouch will get standardised information about the different options, and then choose what treatment they prefer. This study will give us the possibility to compare the two methods prospectively regarding functional outcomes and QoL.
Hear more from Caroline on the ‘IRA, pouch, or Kock's pouch for UC’ at ESCP Virtually Vilnius 2020 at 17:25-18:05 on Monday 21 September 2020.