Original article
Alimentary tract
Detection of Dysplasia or Cancer in 3.5% of Patients With Inflammatory Bowel Disease and Colonic Strictures

https://doi.org/10.1016/j.cgh.2015.04.185Get rights and content

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.

Section snippets

Identification of Cases

All 42 members of GETAID in France, Belgium, and Netherlands were invited to participate in this study. Only centers having access to a clinical, surgical, or pathologic database including all consecutive adult patients operated on for IBD could participate. Inclusion criteria were (1) adults (≥18 years old) with CD, UC, or unclassified colitis (IBD-U), (2) operated on for colonic stricture, and (3) no colonic dysplasia or cancer known at the time of surgery (preoperative endoscopic colonic

Study Population

By selecting only GETAID centers with a database enrolling consecutive IBD patients, 12,013 IBD patients operated on for IBD in 16 GETAID centers between August 1992 and January 2014 were screened. We identified 293 patients (2.3%) operated on for a colonic stricture with preoperative endoscopic colonic biopsies free of dysplasia/cancer, including 248 CD, 39 UC, and 6 IBD-U patients (Figure 1). Note that we evaluated in one center the number of patients with preoperative diagnosis of dysplasia

Discussion

The management of IBD patients with colonic stricture(s) remains a challenge in clinical practice. We report here the largest study evaluating the risk of dysplasia or cancer complicating colonic strictures in IBD. More than 12,000 IBD patients operated on for IBD between 1992 and 2014 were screened to identify 293 patients operated on for colonic strictures. Importantly, only strictures without dysplasia or cancer known at the time of surgery were included.

In case of cancer or HGD on colonic

Acknowledgments

The authors thank Patricia Détré, Association Francois Aupetit. This work was presented in part and orally at the European Crohn’s and Colitis Organization (ECCO) meeting in Copenhagen in 2014, at the Digestive Disease Week (DDW) in Chicago in 2014, and at the UEG week in Vienna in 2014.

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Conflicts of interest The authors disclose no conflicts.

Funding Supported by Association François Aupetit (AFA).

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