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DOP095. Risk of dysplasia and cancer complicating colonic strictures in inflammatory bowel disease: a GETAID study

M. Fumery1, A. Amiot2, X. Hebuterne3, S. Nancey4, V. Abitbol5, C. Stefanescu6, J.-P. Le Mouel1, A. Bressenot7, Y. Bouhnik6, L. Peyrin-Biroulet7, 1CHU Amiens, Gastroenterologie France, 80, Amiens, France, 2Hôpital Henri-Mondor, Gastroenterologie, Creteil, France, 3CHU de Nice, Gastroenterologie, Nice, France, 4Hospices Civils de Lyon, Lyon-Sud hospital, Gastroenterology, Pierre Benite, France, 5Hôpital Cochin, Gastroenterology, Paris, France, 6Hopital Beaujon - APHP, Gastroenterologie, Clichy, France, 7CHU de Nancy, Gastroenterologie, Vandoeuvre-les-Nancy, France

Background

Management of colonic strictures complicating inflammatory bowel disease (IBD) is a challenge in clinical practice and leads frequently to surgical resection because of the fear of associated dysplasia/cancer. The risk of intestinal dysplasia or cancer complicating colonic strictures in both ulcerative colitis (UC) and Crohn's disease (CD) is unknown. We aimed to determine the frequency of dysplasia and cancer among adult patients with IBD undergoing intestinal resection for a colorectal stricture without dysplasia or cancer known at the time of surgery.

Methods

The GETAID conducted a nationwide retrospective study. Only centers having a database of all consecutive IBD patients who underwent intestinal resection for IBD during a given period could participate in this study. All patients with preoperative evidence of dysplasia/cancer were excluded. Demographical, clinical, endoscopic, surgical, and histopathological data and outcomes were collected.

Results

Among 4059 IBD patients operated for IBD in 6 GETAID centers between June 1994 and October 2013, we identified 99 patients operated for a colonic stricture, including 74 CD, 23 UC and 2 IBD unclassified. 52 (52%) were males and the median age at stricture diagnosis was 42 years (Q1 = 31–Q3 = 57). All patients underwent preoperative colonoscopy. The stricture was not passable in 64% of cases. The median disease duration at stricture diagnosis was 9 (4–15) years. Strictures presented a median length of 5 cm (3–9), and were symptomatic in 60% of patients. They were located in the right colon, transverse, or left or rectal in respectively 16%, 16%, 62% and 6% of CD patients, and respectively 7%, 13%, 47% and 33% in UC. Surgical procedure was segmental, subtotal colectomy and coloprotectomy in respectively 85%, 12% and 3% of CD patients and in respectively 17%, 35% and 48% in UC. In CD, low-grade dysplasia was observed in one patient (1.5%), high-grade dysplasia in one patient (1.5%) and no cancer was observed. In UC, cancer was observed in one (4%) patient and low-grade dysplasia in one patient (4%). The median follow-up after strictures resection was 4.7 years (2–8.3). All patients with dysplasia or cancer received a curative surgery, but one patient died of colorectal cancer. Among the 95 patients without dysplasia or cancer on surgical specimen, one patient was diagnosed with a colonic dysplasia at maximal follow-up.

Conclusion

In this cohort of 99 IBD patients undergoing intestinal resection for colonic stricture, dysplasia or cancer were observed in 4% of cases. These findings should be taken into account to guide decision in IBD patients with colonic strictures in clinical practice.