Detection of Dysplasia or Cancer in 3.5% of Patients With Inflammatory Bowel Disease and Colonic Strictures
Detection of Dysplasia or Cancer in 3.5% of Patients With Inflammatory Bowel Disease and Colonic Strictures
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DOI：
10.1016/j.cgh.2015.04.185
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发表时间：
2015-10-01
影响因子：
12.6
通讯作者：
Peyrin-Biroulet, Laurent
中科院分区：
文献类型：
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作者：
Fumery, Mathurin;de Chambrun, Guillaume Pineton;Peyrin-Biroulet, Laurent
背景与目的：结肠狭窄使炎症性肠病（IBD）复杂化，通常需要手术切除以预防异型增生或癌症。我们评估了IBD患者切除结直肠stencture.METHODS的不典型增生和癌症的发生率：我们分析了来自Groupe detudes et therapeutiques des affections inflammatoires du tube digestif研究的数据。这是一项全国性回顾性研究，纳入了1992年8月至2014年1月在法国16家中心接受狭窄手术的12，013例IBD患者（293例结肠狭窄患者，248例克罗恩病患者，51%为男性，狭窄诊断时的中位年龄为38岁）。参与者术前没有发育不良或癌症的证据。我们收集了临床，内镜，手术和病理学数据和outcome.RESULTS信息：当患者被诊断为狭窄，他们有IBD的中位数时间为8年（3-14）。狭窄的平均长度为6 cm（4-10），并在70%的患者中引起症状。在克罗恩病患者中，发现3例（1%）有低度异型增生，1例（0.4%）有高度异型增生，2例（0.8%）有癌症。在溃疡性结肠炎患者中，1例（2%）有低度异型增生，1例（2%）有高度异型增生，2例（5%）有癌症。除1例在随访期间死于结直肠癌外，所有异型增生或癌症患者均接受了根治性手术。手术时无活动性疾病是狭窄部位异型增生或癌症的唯一相关因素（比值比，4.86; 95%置信区间，1.11-21.27; P = 0.036）。结论：在一项对接受结肠狭窄手术的IBD患者的回顾性研究中，发现3.5%的患者患有异型增生或癌症。这些发现可用于指导IBD和结肠狭窄患者的管理。
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 detudes et therapeutiques 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.