Dysplasia in the ileoanal pouch or the rectal cuff is a very rare complication after IPAA [84, 85]. Reported potential risk factors are cancer or dysplasia in the colectomy specimen, chronic pouchitis, and the time after IPAA . The risk of developing dysplasia or cancer after IPAA had promoted us to perform annual surveillance by pouch endoscopy with random mucosal sampling from the pouch and the rectal cuff. Of note, in our pouch clinic, out of 105 patients screened of which 17% had diagnosed dysplasia or cancer in the colectomy specimen, none had cancer or dysplasia in the pouch or rectal cuff after a mean follow-up of 57 months (range 1-258) post IPAA.
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