To inform the committee, NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 2 sources, which was discussed by the committee. The evidence included 2 retrospective case series and is presented in table 2 of the overview.
The specialist advisers and the committee considered the key efficacy outcomes to be: continent ileal pouch and quality of life.
The specialist advisers and the committee considered the key safety outcomes to be: faecal peritonitis, infection, valve slippage, fistula formation, intestinal obstruction, stoma stenosis and bleeding.
Patient commentary was sought but none was received.
The committee noted that the ileum needs to rest for 3 weeks after the procedure. In the published evidence reviewed by the committee, this was done by keeping the patient nil by mouth and using intravenous nutrition. The committee was informed that an alternative approach would be to create a defunctioning ileostomy at the time of the procedure, which would subsequently be reversed.
Patients should be offered appropriate counselling about the effect the procedure may have on their quality of life, including about support from stoma nurses.
The committee was informed that the procedure is primarily for patients with ulcerative colitis, and is commonly done after failure of an ileal pouch-anal anastomosis.
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