Risk Factors of Colorectal Stricture Associated with Developing High-Grade Dysplasia or Cancer in Ulcerative Colitis: A Multicenter Long-term Follow-up Study

Abstract

Background/Aims: The risk factors of colorectal stricture associated with ulcerative colitis (UC) carcinogenesis in the long-term disease duration remain unclear. Methods: This study included all UC patients registered from a prospectively maintained database between June 1986 to July 2018. The demographic data, clinical features, and outcomes in patients with dysplasia and stricture were assessed using univariable analysis and multivariate logistic regression models. Results: A total of 246 eligible patients were included in the analysis. The median follow-up time was 13.0 years (interquartile range [IQR], 9.0 to 16.0). There were 35 cases (14.2%) of colorectal stricture. Patients with stricture had worse clinical outcomes. Stricture formation (odds ratio [OR], 9.350; 95% confidence interval [CI], 2.842 to 30.762), inflammatory polyps (OR, 5.464; 95% CI, 1.692 to 17.638), disease duration of more than 10 years (OR, 3.223; 95% CI, 1.040 to 9.985), and age >40 years at diagnosis (OR, 8.499; 95% CI, 1.903 to 37.956) were significantly associated with high-grade dysplasia or colorectal cancer. In addition, disease duration of more than 5 years (OR, 3.211; 95% CI, 1.168 to 8.881), moderated anemia (OR, 3.373; 95% CI, 1.472 to 7.731), and primary sclerosing cholangitis (OR, 5,842; 95% CI, 1.395 to 24.468) were contributing factors for the development of colorectal stricture. Conclusions: Colorectal stricture had the highest risk for malignant transformation. Earlier initiation of colonoscopic surveillance in UC patients with risk factors for stricture should be considered to prevent stricture formation and further malignant transformation.

Incidence of and Risk Factors for Colorectal Strictures in Ulcerative Colitis: A Multicenter Study

“…The association between long-standing disease and risk for colorectal stricture has been supported in several studies. 2,4,7,14 The median time from UC diagnosis to stricture onset was 11.5 years (5; 15.3) in our cohort, whereas previous studies reported a median time of stricture onset ranging from 13.3 years 17 to 15.6 years. 14 Of note, no study investigated the association between age at diagnosis and stricture occurrence.…”

“…4 However, our work did not succeed to find a significant association with the use of biologics and the reduction of stricture occurrence. Recently, a multicenter cohort study by Xu et al 7 reported a higher percentage of stenosis in UC patients (14.2%). However, this has some limitations.…”

“…Similarly, a recent multicenter study confirmed that cancer was diagnosed in one fourth of UC patients with strictures (25.7%). 7 In another retrospective study including IBD patients undergoing surgery for colonic strictures, dysplasia and cancer were both detected in 10% of UC patients. 9 Disease duration and presence of stenosis are proven risk factors for the development of colorectal neoplasia in UC patients.…”

“…6 The colorectal stricture is a challenging condition to treat, and it is a topic of particular relevance because dysplasia or cancer can be detected in patients with strictures. 7,8 Indeed, in a multicenter retrospective study including 12,013 IBD patients undergoing surgery for colonic strictures, dysplasia or cancer was found in 2.4% of CD cases and up to 10% of UC patients. 9 Although it is a welldescribed complication, its physiopathology remains unclear.…”

The Clinical Significance and Risk Factors of Colorectal Stricture in Ulcerative Colitis

“…In this issue of Gut and Liver , Xu et al . 7 analyzed UC patients registered in a prospectively maintained Chinese database, using univariate and multivariate logistic regression analyses, to examine the risk factors for colorectal stricture associated with UC carcinogenesis over long-term disease duration. The analysis included 246 eligible patients in total, and the median follow-up time was 13.0 years (interquartile range, 9.0–16.0).…”