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. 2024 May 16;3(6):731-737.
doi: 10.1016/j.gastha.2024.05.003. eCollection 2024.

Long-Term Neoplastic Risk Associated With Colorectal Strictures in Crohn's Disease: A Multicenter Study

Thomas Hunaut  1 , Laurent Peyrin-Biroulet  2   3   4   5   6 , Antoine Le Bozec  7 , Adeline Germain  8 , Corinne Gower-Rousseau  9 , Charles Sabbagh  10   11 , Guillaume Cadiot  1 , Mathurin Fumery  12
Affiliations

Long-Term Neoplastic Risk Associated With Colorectal Strictures in Crohn's Disease: A Multicenter Study

Thomas Hunaut et al. Gastro Hep Adv. .

Abstract

Background and aims: While the occurrence of colonic stricture in Crohn's disease (CD) always raises concerns about the risk of cancer, the neoplastic risk associated with its stricture remains poorly known.

Methods: All consecutive patients with colorectal stricture complicating CD in 3 academic centers between 1993 and 2022 were included in a retrospective cohort. We collected clinical, endoscopic, surgical, and pathology data and information on outcomes. Factors associated with neoplastic stricture were investigated by logistic regression.

Results: A total of 88 patients (median age, 25 [interquartile range {IQR}, 19-37] years and median disease duration 12 [4-19] years) with 96 colorectal strictures were included. Strictures were nonpassable by the scope in 61.4% (n = 54) of cases, 70.5% (n = 62) were ulcerated, and 62.5% (n = 55) were symptomatic. Colonic resection and endoscopic balloon dilatation were needed in 47.7% (n = 42) and 28.6% (n = 12) of patients, respectively. After a median follow-up of 21.5 months (IQR [5.5-46.5]), 7 (8%) patients were diagnosed with neoplasia at the colonic stricture site (colonic adenocarcinoma, n = 5; neuroendocrine carcinoma, n = 1; and B-cell lymphoproliferative neoplasia, n = 1), with a median stricture duration at colorectal neoplasia diagnosis of 0 month (IQR [0.0-5.5]). While neoplastic strictures were diagnosed in older patients (58 vs 39 years), with longer disease duration (18 vs 11 years) and frequent obstructive symptoms (57.1% vs 11.1%), no patient-related or stricture-related factor was associated with neoplastic stricture in multivariate analysis.

Conclusion: Eight percent of patients with colonic stricture complicating CD developed colorectal cancer. Colorectal cancer and stricture were often diagnosed at the same time and we did not report malignant stricture after 1 year of follow-up.

Keywords: Cancer; Colonic Stricture; Crohn’s Disease.

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Figures

Figure
Figure
Cumulative risk of malignant stricture in patients with Crohn’s disease.
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