S2026 Suboptimal Surveillance in IBD Patients With Ileal Pouch-Anal Anastomosis: A Single Center Experience

Introduction: Patients with ulcerative colitis (UC) who undergo total colectomy with ileal pouch-anal anastomosis (IPAA) remain at risk for colorectal neoplasia given the presence of a rectal cuff in most patients. This is especially true in those with high-risk features, such as prior dysplasia, primary sclerosing cholangitis, extensive or long-standing colitis, and a personal or family history of colorectal cancer. While only 10–12% of UC patients post-IPAA are considered high risk, current guidelines recommend interval pouch surveillance every 1–3 years for high-risk individuals and every 3 years for low-risk individuals. However, real-world adherence to these recommendations remains unclear. Methods: We conducted a quality improvement project involving 110 patients with ulcerative colitis and an IPAA at a tertiary care center. Given that the majority of UC patients are considered low risk and are therefore recommended to undergo surveillance pouchoscopy every 3 years, we used this interval as our benchmark for assessing compliance. Using a cutoff date of May 1, 2025, we identified patients who were overdue for screening. Patients were defined as adherent if they had undergone at least one pouchoscopy after surgery within the recommended 3-year interval. Results: Of the 110 patients included in our analysis, 94 (85.3%) were overdue for surveillance pouchoscopy. Of the 94 patients, 62 (65.9%) never had any post operatively pouchoscopy performed. Additionally, of the 94 patients overdue for surveillance, only 11 patients (32.4%) have an active endoscopy order in place. Only 40/110* patients (34%) had any documented pouchoscopy performed. Conclusion: Despite guideline recommendations, adherence to surveillance pouchoscopy in UC patients post-IPAA appears alarmingly low, even when assuming a low-risk designation. More than half of patients have never undergone a post-surgery endoscopic assessment, and over 60% of previously assessed patients are overdue for another pouchoscopy. These findings highlight a critical gap in long-term IBD care and underscore the need for system-level interventions to improve surveillance adherence for this patient population.