Sensitivity and specificity of diagnostic modalities in pouchitis: a systematic review and meta-analysis.

Luis Miguel Nieto, Afia Iqbal, Danilo Vinci, Danujan Sriranganathan, Gianluca Pellino, Jonathan P Segal

Journal: European journal of gastroenterology & hepatology 2023;35(11):1237-1243

PMID: 37695613

Abstract

Restorative proctocolectomy (RPC) is the most common surgical procedure to restore gastrointestinal continuity after surgical resection of the colon and rectum. Pouchitis is a common complication with several different modalities that can be used to aid diagnosis. This systematic review and meta-analysis aimed at exploring the sensitivity and specificity these diagnostic modalities. The medical literature was searched using MEDLINE, EMBASE and EMBASE classic and PubMed from 1978 to June 2022. We calculated descriptive statistics using sensitivity, specificity, and false-positive rate of the primary studies and also their positive and negative likelihood ratios, and their diagnostic odds ratios. The screen found 5477 records with 13 studies being included. Faecal lactoferrin was found to have the highest pooled sensitivity and specificity of 98% and 88% respectively with imaging modalities coming in second and faecal calprotectin third with pooled sensitivities and specificities of 87% and 79% and 74% and 81% respectively. Faecal biomarkers particularly lactoferrin and imaging modalities may have an important role to play in diagnosing pouchitis. Importantly due to delays in availability of pouchoscopy, our data supports early ordering of these tests to help delineate from other causes. Further studies are required with larger cohort sizes to further validate these tests.

Address: Department of Internal Medicine, Wellstar Cobb Medical Center, Austell, Georgia, USA.; Department of Gastroenterology, Northern Hospital, Epping, Melbourne, Australia.; Department of Surgical Science, University Tor Vergata, Rome, Italy.; Department of Gastroenterology, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.; Department of Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain.; Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.; Department of Medicine, University of Melbourne.; Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Melbourne, Australia.

DOI: 10.1097/MEG.0000000000002638

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MeSH Terms: Humans, Pouchitis, Lactoferrin, Proctocolectomy, Restorative, Sensitivity and Specificity, Feces