Bo Shen, MD, (pictured right) and Feza H. Remzi, MD, Chairman of the Department of Colorectal Surgery. Image © Cleveland Clinic
for redo pouches or pouch revision surgery. Pouchitis Clinic surgeon Feza H. Remzi,
MD, Chairman, Department of Colorectal Surgery, at Cleveland Clinic, says Cleveland Clinic’s high volume of cases ensures experience with complex issues of reoperation. “This may include performing a major
laparotomy, abdominal pelvic pouch mobilization with disconnection and creating a new hand-sewn anastomosis,” Dr. Remzi says. “Under these circumstances, we may either salvage the old pouch or create a new pouch. It is critical we eliminate the septic focus related to the failed anastamosis and its related complications.” Those seen at the Pouchitis Clinic
form a patient-gastroenterology-surgeon relationship that ensures ongoing collaboration and follow-up. The Pouchitis Clinic is also home to approximately 60 percent of the pouchitis research conducted in the United States, with 40 to 50 pouch-related manuscripts published annually, offering patients access to the latest technologies and cutting-edge studies. Clinical and translational research at the Pouchitis Clinic has been supported by the National Institutes of Health, American College of Gastroenterology, American Society of Colorectal Surgeons, Crohn’s and Colitis Foundation of America, and Broad Foundation. Specialists at the Pouchitis Clinic have
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«Cleveland Clinic’s Pouchitis Clinic is the world’s first and largest for treating pouch- associated disorders»
also established innovative techniques to classify, diagnose and treat different aspects of pouch-related issues, Dr. Shen says. “Pouchitis used to be a mixed bag of everything together,” explains Dr. Shen. “Now, we sub-classify them based on etiology, disease mechanism, clinical presentations and disease course. If we have the correct classification, there’s the proper solution. It’s a much more analytical approach to diagnosis and treatment.” The infrastructure of the Pouchitis
Clinic has also helped clinicians when diagnosing new categories of diseases of the pouch. Those include irritable pouch syndrome, afferent and efferent limb syndrome, ischemic pouchitis, autoimmune pouchitis, immunoglobulin G4 (IgG4)- associated pouchitis and primary sclerosing cholangitis (PSC)-associated pouchitis. One of the biggest challenges is that
there’s no FDA-approved medication for any pouch disorders,” Dr. Shen says. “Current therapy is largely empiric. Basically, we have been using established treatments for the new ‘indications.’
”One of the more recent
breakthroughs is the use of supercharcoal to treat pouchitis by absorbing bacterial toxins rather than destroying the bacteria. Doctors at the Pouchitis Clinic are also seeing positive results with the use of intravenous immunoglobulin treatment for pouchitis. And the Pouchitis Clinic has become the leader in the therapeutic use of pouch endoscopies. The specialists in the Pouchitis
Clinic have developed novel endoscopic approaches to pouch disorders, including endoscopic balloon dilation therapy and needle knife therapy to treat strictures, and needle knife therapy to treat pouch anastomotic leaks and sinuses. They perform 400 to 500 therapeutic endoscopies for pouch disorders each year, the majority of which are performed in an outpatient setting. Pouchitis Clinic specialists are also
currently studying the bacterial profile of the pouch, hepatobiliary disorders’ impact on the pouch, and cancer risk for pouch patients. “Innovative thinking and research continues to bring proven results to our patients,” Dr. Remzi says. ■
AH
REFERENCES To refer a patient to the Pouchitis Clinic, call +1 216.444.7000. Contact Dr. Remzi at +1 216.445.5020 or
remzif@ccf.org and Dr. Shen at +1 216.444.9252 or
shenb@ccf.org.
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