Hunaut Thomas, Peyrin-Biroulet Laurent, Le Bozec Antoine, Germain Adeline, Gower-Rousseau Corinne, Sabbagh Charles, Cadiot Guillaume, Fumery Mathurin
Department of Gastroenterology, Reims University Hospital, Université de Champagne-Ardenne, Reims, France.
Department of Gastroenterology, Nancy University Hospital, Vandœuvre-lès-Nancy, France.
Gastro Hep Adv. 2024 May 16;3(6):731-737. doi: 10.1016/j.gastha.2024.05.003. eCollection 2024.
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.
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.
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.
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.
虽然克罗恩病（CD）中结肠狭窄的发生总是引发对癌症风险的担忧，但其狭窄相关的肿瘤风险仍知之甚少。
纳入1993年至2022年间3个学术中心所有并发CD的结直肠狭窄连续患者，进行回顾性队列研究。我们收集了临床、内镜、手术和病理数据以及结局信息。通过逻辑回归研究与肿瘤性狭窄相关的因素。
共纳入88例患者（中位年龄25岁[四分位间距{IQR}，19 - 37岁]，中位病程12年[4 - 19年]），有96处结直肠狭窄。61.4%（n = 54）的病例狭窄处内镜无法通过，70.5%（n = 62）有溃疡，62.5%（n = 55）有症状。分别有47.7%（n = 42）和28.6%（n = 12）的患者需要进行结肠切除和内镜球囊扩张。中位随访21.5个月（IQR[5.5 - 46.5]）后，7例（8%）患者在结肠狭窄部位被诊断为肿瘤（结肠腺癌，n = 5；神经内分泌癌，n = 1；B细胞淋巴增殖性肿瘤，n = 1），结直肠肿瘤诊断时的中位狭窄持续时间为0个月（IQR[0.0 - 5.5]）。虽然肿瘤性狭窄在年龄较大的患者（58岁对39岁）、病程较长（18年对11年）且有频繁梗阻症状（57.1%对11.1%）的患者中被诊断出，但多因素分析中没有患者相关或狭窄相关因素与肿瘤性狭窄相关。
8%并发CD的结肠狭窄患者发生了结直肠癌。结直肠癌和狭窄常同时被诊断出，且随访1年后未报告恶性狭窄。
