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

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.

Automated summary

Restorative proctocolectomy (RPC) is the most common surgical procedure for restoring gastrointestinal continuity after colon and rectal surgery. Pouchitis is a common complication, and various modalities can be used for diagnosis. This systematic review and meta-analysis aimed to explore the sensitivity and specificity of these diagnostic modalities. The results showed that fecal lactoferrin had the highest pooled sensitivity and specificity of 98% and 88% respectively, followed by imaging modalities, and fecal calprotectin had sensitivities and specificities of 87% and 79% and 74% and 81% respectively. Fecal biomarkers, particularly lactoferrin, and imaging modalities may play an important role in diagnosing pouchitis.