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

Mathurin Fumery (1, 2) , Guillaume Pineton De Chambrun (3) , Carmen Stefanescu (1) , Anthony Buisson (4) , Aude Bressenot (5) , Laurent Beaugerie (6, 7) , Aurelien Amiot (8) , Romain Altwegg (9) , Guillaume Savoye (10, 11, 12, 13) , Vered Abitbol (14) , Guillaume Bouguen (15, 16) , Marion Simon (17) , Jean-Pierre Duffas (18) , Xavier Hebuterne (19) , Stéphane Nancey (20) , Xavier Roblin (21) , Emmanuelle Leteurtre (22) , Gilles Bommelaer (4) , Jeremie H. Lefevre (7) , Francesco Brunetti (23) , Françoise Guillon (9) , Yoram Bouhnik (1) , Laurent Peyrin-Biroulet (5)

1 Pole des maladies de l'appareil digestif, gastroentérologie et assistance nutritive
2 CHU Amiens-Picardie
3 Hôpital Claude Huriez [Lille]
4 CHU Clermont-Ferrand
5 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux
6 UPMC - Université Pierre et Marie Curie - Paris 6
7 CHU Saint-Antoine [AP-HP]
8 Service de gastro-entérologie [Henri Mondor AP-HP, Créteil]
9 Hépato-gastro-entérologie
10 ADEN - Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
11 IRIB - Institute for Research and Innovation in Biomedicine
12 UNIROUEN UFR Santé - UNIROUEN - UFR Santé
13 Service d'Hépato-Gastroentérologie [CHU Rouen]
14 Département de gastroentérologie
15 Foie, métabolismes et cancer
16 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
17 IMM - Institut Mutualiste de Montsouris
18 Chirurgie Générale et Digestive [Rangueil]
19 CHU Nice - Centre Hospitalier Universitaire de Nice
20 Service d'hépato-gastroentérologie
21 Département de gastro-entérologie et Hépatologie
22 JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837
23 CHU Henri Mondor [Créteil]

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 was 38 y). 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 y (3−14 y). The strictures were a median length of 6 cm (4−10 cm) and caused symptoms in 70% of patients. Of patients with Crohn’s disease, 3 were found to have low-grade dysplasia (1%), 1 was found to have high-grade dysplasia (0.4%), and 2 were found to have cancer (0.8%). Of patients with ulcerative colitis, 1 had low-grade dysplasia (2%), 1 had high-grade dysplasia (2%), and 2 had cancer (5%). 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). Conclusion 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.

Mots clés: colon; CD; carcinogenesis; UC; GETAID study; colon cancer risk factors; dysplasia; cancer; stricture; inflammatory bowel disease

Domaines: Sciences du Vivant [q-bio]; Cancer

Mathurin Fumery, Guillaume Pineton De Chambrun, Carmen Stefanescu, Anthony Buisson, Aude Bressenot, et al.. Detection of Dysplasia or Cancer in 3.5% of Patients with Inflammatory Bowel Disease and Colonic Strictures. Clinical Gastroenterology and Hepatology, 2015, 13 (10), pp.1770-1775. ⟨10.1016/j.cgh.2015.04.185⟩. ⟨hal-01154234⟩