Benign and malignant colorectal strictures in ulcerative colitis. Gut

Department of Medicine, Mount Sinai School of Medicine, City University of New York, NY.
Gut (Impact Factor: 14.66). 08/1992; 33(7):938-41. DOI: 10.1136/gut.33.7.938
Source: PubMed


Colorectal strictures, either benign or malignant, are not uncommon in ulcerative colitis. Fifty nine of 1156 ulcerative colitis patients (5%) admitted to this hospital between 1959 and 1983 developed 70 separate colorectal strictures. Seventeen of the 70 strictures (24%) proved to be malignant and the other 53 benign. Nine patients developed more than one stricture. Three principal features distinguished the 17 malignant from the 53 benign strictures in this series: (1) appearance late in the course of ulcerative 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).

Download full-text


Available from: David B Sachar
  • Source
    • "Benign colonic strictures were reported in 3.6 to 11.2% of UC patients, in previous studies [19-21]. An extensive study on strictures in UC was conducted by Gamaste et al on 1156 UC patients from Mt Sinai [21]. They found benign strictures in 42 patients (3.6%) after mean disease duration of 14.5 years. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The clinical course of ulcerative colitis (UC) may range from a quiescent course with prolonged periods of remission to fulminant disease requiring intensive medical treatment or surgery. Disease outcome is often determined by relapse rates, the development of colorectal cancer (CRC) and mortality rates. Early patient classification, identifying those with a high risk of developing complicated disease, is essential for choosing appropriate treatment. This paper reviews the clinical outcomes of UC patients as reported in population-based and observational studies representative of the whole patient population. Extensive colitis, a high level of systemic symptoms and young age at diagnosis are factors associated with a high risk of colectomy. Patients with distal disease who progress to extensive colitis seem to be a subgroup with an especially high risk of colectomy. Some prognostic factors of severe disease have been identified which could be used to optimize treatment and possibly reduce future complications. The overall risk of CRC and mortality was not significantly different from that of the background population. These results may have implications for follow-up strategies, especially regarding endoscopic surveillance of UC patients.
    Full-text · Article · Mar 2014 · Annals of Gastroenterology
  • Source
    • "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). "

    Full-text · Chapter · Jan 2012
  • Source
    • "Stricture develops in 5% to 10% of patients who have ulcerative colitis, and up to 25% are malignant. Strictures that occur in patients who have longstanding colitis, are proximal to the splenic flexure, or are symptomatic have a higher risk for malignancy [11]. Although biopsy of strictures may be helpful, it is often unreliable in the diagnosis of dysplasia or malignancy [12] [13], and therefore resection is reasonable. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Surgical therapy of ulcerative colitis is effective, safe, and provides an improved quality of life in those whose disease cannot be managed medically. In the elective setting, widespread acceptance of restorative proctocolectomy has made surgical therapy an attractive option in the overall management of ulcerative colitis. Enthusiasm for this procedure should be tempered by the acknowledgment of the significant incidence of pouchitis in the long term, however. Proctocolectomy with ileostomy remains a good surgical option for patients who are unsuitable for restorative procedures. The standard therapy for fulminant colitis or toxic megacolon remains subtotal colectomy with ileostomy. Patients undergoing subtotal colectomy are candidates for conversion to restorative procedures.
    Preview · Article · Jul 2007 · Surgical Clinics of North America
Show more