It’s actually most important that the rectal cuff be biopsied. It’s the only colonic tissue remaining in your body. If you have any history of inflammation in the cuff or the pouch or a pre-surgical history of dysplasia, it absolutely should be biopsied every year. Cancer, although rare in J Pouchers, would be more likely to start in the rectal cuff than the Pouch with such histories.  My recollection is that Cleveland Clinic did a study on Pouch cancers about 9 years ago and my then GI, who interned with Dr. Shen there and was involved in the study, shared with me the results.  Pretty much all the cancers were in people who had severe uncontrolled pouchitis and/or cuffitis and it was originating in the rectal cuff.

Below in quotes is the biopsy report from Yale on my recent scope of August 1, 2018, which I am posting for comments of anyone who wants to make one, and also to note the disclaimer included by the radiologist on Crohn's which I think is now standard and essentially shows how nonsensical it is to break one drop of sweat on any Chrohn's diagnosis because I can bet cash money that a lot of the people who have posted they were told they had Crohn's also had this disclaimer in their biopsy results if they read them carefully.  I have only edited this to remove personal identifying information:

"SURGICAL PATHOLOGY REPORT

FINAL DIAGNOSIS

1) COLON, "LOOP ANASTOMOSIS", BIOPSY:

- SMALL BOWEL-TYPE MUCOSA WITH MODERATE INFLAMMATORY AND REACTIVE EPITHELIAL CHANGES, CONSISTENT WITH ANASTOMOTIC SITE
- NEGATIVE FOR DYSPLASIA OR MALIGNANCY

2) POUCH, ULCER, BIOPSY:

- SMALL BOWEL-TYPE MUCOSA WITH MODERATE ACUTE AND CHRONIC INFLAMMATORY CHANGES CONSISTENT WITH POUCHITIS
- NEGATIVE FOR DYSPLASIA OR MALIGNANCY

3) SMALL BOWEL, "ILEAL CUFF", BIOPSY:

- SMALL BOWEL MUCOSA WITH MODERATE CHRONIC INFLAMMATORY CHANGES WITH AREAS OF PYLORIC GLAND METAPLASIA
- NEGATIVE FOR GRANULOMATOUS INFLAMMATION, DYSPLASIA OR MALIGNANCY
- ONE FRAGMENT APPEARS TO BE COLONIC-TYPE MUCOSA WITH SQUAMOUS EPITHELIUM, LIKELY FROM ANORECTAL JU
NCTION

NOTE: The biopsies from the "ileal cuff" reveal few fragments of small bowel mucosa with chronic inflammatory changes and pseudopyloric metaplasia. In addition, one fragment appears to be colonic-type with junctional squamous mucosa and a minute fragment
of squamous epithelium. This suggests these biopsies may be from anorectal junction. None of the biopsies reveal any evidence of granulomatous inflammation; however, correlation with clinical findings is needed to confirm or exclude the possibility of 
Crohn's disease. Correlation with clinical findings is suggested. 


Pathologist: Dhanpat Jain, M.D. 
8/2/2018 18:36 * Report Electronically Signed Out *


This electronic signature indicates that the pathologist has personally reviewed the available gross and/or microscopic material and has based the diagnosis on that evaluation.


Specimen(s) Received:
1:A LOOP ANASTOMOSIS BIOPSIES
2:ULCER IN POUCH BIOPSIES
3:ILEAL CUFF
BIOPSIES


Clinical History and Impression:
Ileal anal pouch
likely Crohn's



Gross Description: (Dhanpat Jain, M.D. ; Whitney L. Johnson)
1. Received in formalin, labeled with the patient's name and " A loop anastomosis" is a 0.6 x 0.5 x 0.1 cm tan irregular soft tissue which is submitted in toto in one cassette.

2. Received in formalin, labeled with the patient's name and "ulcer in pouch" are 3 tan irregular soft tissues ranging from 0.1 x 0.1 x 0.1 cm to 0.4 x 0.2 x 0.1 cm which are submitted in toto in one cassette.

3. Received in formalin, labeled with the patient's name and "ileal cuff" are 3 tan irregular soft tissues ranging from 0.3 x 0.3 x 0.1 cm to 0.6 x 0.4 x 0.1 cm which are submitted in toto in one cassette."

The radiologist notes "likely Crohn's" but also: "None of the biopsies reveal any evidence of granulomatous inflammation; however, correlation with clinical findings is needed to confirm or exclude the possibility of 
Crohn's disease. Correlation with clinical findings is suggested."

So guess what the result of the clinical findings are/were after spending a mountain of cash obtaining them:

"We don't freaking know!!!!!!!!!!!!!!"

 

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