Benign and malignant colorectal strictures in ulcerative colitis.

Abstract

(1) appearance late in the course ofulcerative colitis (61% probability of malignancy in strictures that develop after 20 years of disease v 0% probability in those occurring before 10 years); (2) location proximal to the splenic flexure (86% probability of malignancy v 47% in sigmoid, 10% in rectum, and 0% in splenic flexure and descending colon); and (3) symptomatic large bowel obstruction (100% probability of malignancy v only 14% in the absence of obstruction or constipation). Moreover, cancer associated with strictures tends to be more advanced (76% stage D, 24% A and B) than that which does not produce strictures (18% stage D, 59% A and B).Enteric strictures are a common complication of Crohn's disease, occurring most frequently in the small bowel. Colorectal strictures are less frequent and occur in both Crohn's disease and ulcerative colitis. The occurrence of a colonic stricture in either form of inflammatory bowel disease raises the question of malignancy. In this study we have examined both benign and malignant colorectal strictures in ulcerative colitis and have compared their features.

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

“…Several studies have shown that most dysplasia is visible at colonoscopy: in approximately three quarters of cases of confi rmed dysplasia, the endoscopist had noted an abnormality during the procedure ( 390 -392 ). Endoscopic features that have been predictive of greater likelihood of presence of dysplasia include the presence of pseudopolyps ( 393,394 ) and colonic strictures ( 393,395,396 ). Although pseudopolyps per se are not premalignant, they indicate a higher degree of previous colonic infl ammation.…”

“…Such fi ndings are an absolute indication for colectomy in patients with HGD ( 413,414 ), and should prompt consideration of colectomy in patients with LGD as well. LGD in a mass lesion ( 415 ) that does not resemble a typical sporadic adenoma and cannot be resected endoscopically (see below), or a stricture that is symptomatic or not passable during colonoscopy ( 393,395,396 ), especially in long-standing disease, is oft en indicative of coexistent colon cancer; hence, colectomy is advisable.…”

Colorectal Cancer in Ulcerative Colitis Patients

“…Another retrospective study of hospitalized patients with UC found the prevalence of strictures to be 5%, with 24% of the strictures being malignant. In all of these cases, the patients had more than twenty years of disease (Gumaste et al, 1992). Similarly, Rutter et al found that both strictures (odds ratio of 4.62) and post-inflammatory polyps (odds ratio of 2.29) conveyed a significantly increased risk of developing CRC (Rutter et al, 2004c).…”

“…Presence of either psuedopolyps or strictures has been reported to increase the risk of CRC by two fold and four fold respectively (Rutter et al, 2004c). Other reports found up to 24% of strictures may be malignant (Gumaste et al, 1992). Additionally, strictures throughout the colon may limit the endoscopists ability to adequately maneuver around them limiting the comprehensiveness of the surveillance examination.…”

“…While post-inflammatory polyps do not develop directly into CRC, they are thought to act as a surrogate marker of previous severe inflammation which has been shown to carry significant risk of CRC (Rutter et al, 2004c). The risk of a malignant stricture increased with disease duration, location proximal to the splenic flexure, and presence of a symptomatic large bowel obstruction (Gumaste et al, 1992).…”