Histopathological features predict pouch failure in ulcerative colitis patients

A study evaluating 417 patients who underwent ileal pouch-anal anastomosis found a 23% risk of pouch failure over 18 years. Key predictors included post-procedure Crohn’s disease and specific histologic features such as deep chronic inflammation and severe disease activity. Single-cell spatial transcriptomics identified immune cell infiltration and disrupted signaling pathways associated with pouch failure. These insights support the importance of histologic and molecular analyses to identify high-risk patients and enhance surgical outcomes.