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Clin Gastroenterol Hepatol. 2015 Oct;13(10):1770-5. doi: 10.1016/j.cgh.2015.04.185. Epub 2015 May 19.

Detection of Dysplasia or Cancer in 3.5% of Patients With Inflammatory Bowel Disease and Colonic Strictures.

Author information

1
Department of Gastroenterology, Amiens University and Hospital, Université de Picardie Jules Verne, Amiens, France; Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France.
2
Department of Gastroenterology, Huriez Hospital, Université Lille Nord de France, Lille, France.
3
Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France.
4
Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France.
5
Department of Pathology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.
6
Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine F-75012, ERL 1057 Inserm/UMRS 7203 and GRC-UPMC 03, UPMC Université Paris 06 F-75005, Paris, France.
7
Department of Gastroenterology, Henri Mondor Hospital, UPEC, Creteil, France.
8
Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France.
9
Department of Gastroenterology, Rouen University and Hospital, Rouen, France.
10
Department of Gastroenterology, Cochin Hospital, University Paris 5 Descartes, Paris, France.
11
Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France.
12
Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
13
Department of Digestive Surgery, Rangueil University Hospital, University of Toulouse, Toulouse, France.
14
Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France.
15
Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France.
16
Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France.
17
Institute of Pathology, Lille University Hospital, Lille, France.
18
Department of Digestive Surgery, Saint-Antoine Hospital, University Paris 6 Pierre and Marie Curie, Paris, France.
19
Digestive Surgery and Liver Transplant Unit, Henri Mondor Hospital, UPEC, Creteil, France.
20
Department of Digestive Surgery, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France.
21
Inserm U954 and Department of Gastroenterology, Université de Lorraine, Nancy, France. Electronic address: peyrinbiroulet@gmail.com.

Abstract

BACKGROUND & AIMS:

Colonic strictures complicate inflammatory bowel disease (IBD) and often lead to surgical resection to prevent dysplasia or cancer. We assessed the frequency of dysplasia and cancer among IBD patients undergoing resection of a colorectal stricture.

METHODS:

We analyzed data from the Groupe d'études et thérapeutiques des affections inflammatoires du tube digestif study. This was a nationwide retrospective study of 12,013 patients with IBD in France who underwent surgery for strictures at 16 centers from August 1992 through January 2014 (293 patients for a colonic stricture, 248 patients with Crohn's disease, 51% male, median age at stricture diagnosis of 38 years). Participants had no preoperative evidence of dysplasia or cancer. We collected clinical, endoscopic, surgical, and pathology data and information on outcomes.

RESULTS:

When patients were diagnosed with strictures, they had IBD for a median time of 8 years (3-14). The strictures were a median length of 6 cm (4-10) and caused symptoms in 70% of patients. Of patients with Crohn's disease, 3 (1%) were found to have low-grade dysplasia, 1 (0.4%) was found to have high-grade dysplasia, and 2 (0.8%) were found to have cancer. Of patients with ulcerative colitis, 1 (2%) had low-grade dysplasia, 1 (2%) had high-grade dysplasia, and 2 (5%) had cancer. All patients with dysplasia or cancer received curative surgery, except 1 who died of colorectal cancer during the follow-up period. No active disease at time of surgery was the only factor associated with dysplasia or cancer at the stricture site (odds ratio, 4.86; 95% confidence interval, 1.11-21.27; P = .036).

CONCLUSIONS:

In a retrospective study of patients with IBD undergoing surgery for colonic strictures, 3.5% were found to have dysplasia or cancer. These findings can be used to guide management of patients with IBD and colonic strictures.

KEYWORDS:

CD; Carcinogenesis; Colon Cancer Risk Factors; GETAID Study; UC

PMID:
26001338
DOI:
10.1016/j.cgh.2015.04.185
[Indexed for MEDLINE]
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