Original articleAlimentary tractDetection of Dysplasia or Cancer in 3.5% of Patients With Inflammatory Bowel Disease 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.
References (20)
- et al.
Risk factors associated with progression to intestinal complications of Crohn's disease in a population-based cohort
Gastroenterology
(2010) - et al.
The second European evidence-based consensus on the diagnosis and management of Crohn's disease: current management
J Crohns Colitis
(2010) - et al.
Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management
J Crohns Colitis
(2012) - et al.
Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 3: special situations
J Crohns Colitis
(2013) - et al.
The natural history of adult Crohn's disease in population-based cohorts
Am J Gastroenterol
(2010) - et al.
Developement of the Crohn’s disease digestive damage score, the Lémann score
Inflamm Bowel Dis
(2011) - et al.
Crohn's disease complicated by strictures: a systematic review
Gut
(2013) - et al.
Ulcerative colitis as a progressive disease: the forgotten evidence
Inflamm Bowel Dis
(2012) - et al.
Submucosal fibrosis and basic-fibroblast growth factor-positive neutrophils correlate with colonic stenosis in cases of ulcerative colitis
Digestion
(2011) - et al.
Dysplasia and cancer complicating strictures in ulcerative colitis
Dig Dis Sci
(1990)
Cited by (77)
Endoscopic Balloon Dilation of Strictures: Techniques, Short- and Long-Term Outcomes, and Complications
2022, Gastrointestinal Endoscopy Clinics of North AmericaDiagnosis and Classification of Inflammatory Bowel Disease Strictures
2022, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :Most societal guidelines advise annual surveillance of IBD colonic strictures, with a low threshold for resection in the presence of dysplasia.42–45 A multidisciplinary discussion of surgical options should be considered regardless of negative biopsies as dysplasia or malignancy has been reported in 3.5% of resected colonic strictures despite negative preoperative biopsies.46 CD-associated primary strictures may be found anywhere along the gastrointestinal tract but are most commonly found in the ileum and the ileocolonic region.2,47
Incidence of and Risk Factors for Colorectal Strictures in Ulcerative Colitis: A Multicenter Study
2021, Clinical Gastroenterology and HepatologyCitation Excerpt :Similarly, a recent multicenter study confirmed that cancer was diagnosed in one fourth of UC patients with strictures (25.7%).7 In another retrospective study including IBD patients undergoing surgery for colonic strictures, dysplasia and cancer were both detected in 10% of UC patients.9 Disease duration and presence of stenosis are proven risk factors for the development of colorectal neoplasia in UC patients.
Endoscopic balloon dilation of colorectal strictures complicating Crohn's disease: a multicenter study
2021, Clinics and Research in Hepatology and GastroenterologySelecting End Points for Disease-Modification Trials in Inflammatory Bowel Disease: the SPIRIT Consensus From the IOIBD
2021, GastroenterologyCitation Excerpt :Most experts (92%) accepted dysplasia or cancer as an outcome measure for future IBD disease-modification trials. This is, indeed, the main problem of subclinical persistent inflammation that progressively leads to conventional or nonconventional dysplasia,31,32 with an increased risk of digestive cancer in both UC33 and CD.34 The expert panel agreed that dysplasia and cancer will have to be distinguished.
Conflicts of interest The authors disclose no conflicts.
Funding Supported by Association François Aupetit (AFA).