Incidence and Neoplastic Risk Associated with Colonic Stricture in Paediatric-Onset Crohn's Disease: A Population-based Study - 20/04/26

Doi : 10.1016/j.clinre.2026.102828

Nicolas Richard ^1,^⁎ , Ariane Leroyer ^2,³, Claire Dupont ⁴, Dominique Turck ^3,⁵, Valérie Bertrand ⁶, Pauline Wils ^3,⁷, Corinne Gower-Rousseau ⁸, Nathalie Guillon ², Guillaume Savoye ¹, Delphine Ley ^3,⁵, Hélène Sarter ^2,³, Mathurin Fumery ⁹

EPIMAD study group ^{^#}
Epimad study group:

R Al Hameedi, M Al Khatib, S Al Turk, E Agoute, JM Andre, M Antonietti, A Aouakli, A Armand, L Armengol-Debeir, I Aroichane, F Assi, JP Aubet, E Auxenfants, A Avram, F Ayafi-Ramelot, K Azzouzi, D Bankovski, B Barbry, N Bardoux, P Baron, A Baudet, P Bayart, B Bazin, A Bebahani, JP Becqwort, S Bellati, V Benet, H Benali, C Benard, C Benguigui, E Ben Soussan, A Bental, I Berkelmans, J Bernet, K Bernou, C Bernou-Dron, P Bertot, N Bertiaux-Vandaële, V Bertrand, E Billoud, N Biron, B Bismuth, M Bleuet, F Blondel, V Blondin, M Bobula, P Bohon, V Bondjemah, E Boniface, D Bonkovski, P Bonnière, E Bonvarlet, P Bonvarlet, A Boruchowicz, R Bostvironnois, M Boualit, A Bouazza, B Bouche, C Boudaillez, C Bourgeaux, M Bourgeois, A Bourguet, A Bourienne, H Boutaleb, A Bouthors, J Branche, G Bray, F Brazier, P Breban, M Bridenne, H Brihier, L Bril, V Brung-Lefebvre, P Bulois, P Burgiere, J Butel, JY Canva, V Canva-Delcambre, JP Capron, F Cardot, S Carette, P Carpentier, E Cartier, JF Cassar, M Cassagnou, JF Castex, P Catala, S Cattan, S Catteau, B Caujolle, G Cayron, C Chandelier, M Chantre, J Charles, T Charneau, M Chavance-Thelu, A Cheny, D Chirita, A Choteau, JF Claerbout, PY Clergue, H Coevoet, G Cohen, R Collet, M Colin, JF Colombel, S Coopman, L Cordiez, J Corvisart, A Cortot, F Couttenier, JF Crinquette, V Crombe, I Dadamessi, H Daoudi, V Dapvril, T Davion, S Dautreme, J Debas, S Decoster, N Degrave, F Dehont, C Delatre, R Delcenserie, D Delesalle, O Delette, T Delgrange, L Delhoustal, JS Delmotte, S Demmane, G Deregnaucourt, P Descombes, JP Desechalliers, P Desmet, P Desreumaux, G Desseaux, P Desurmont, A Devienne, E Devouge, M Devred, A Devroux, A Dewailly, S Dharancy, A Di Fiore, D Djedir, R Djedir, W Doleh, ML Dreher-Duwat, R Dubois, C Duburque, P Ducatillon, J Duclay, B Ducrocq, F Ducrot, P Ducrotte, A Dufilho, C Duhamel, D Dujardin, C Dumant-Forest, JL Dupas, F Dupont, Y Duranton, A Duriez, N Duveau, K El Achkar, M El Farisi, C Elie, MC Elie-Legrand, A Elkhaki, M Eoche, E Essmaeel, D Evrard, JP Evrard, A Fatome, B Filoche, L Finet, M Flahaut, C Flamme, D Foissey, P Fournier, MC Foutrein- Comes, P Foutrein, D Fremond, T Frere, M Fumery, P Gallais, C Gamblin, S Ganga, R Gerard, G Geslin, Y Gheyssens, N Ghossini, S Ghrib, T Gilbert, B Gillet, D Godart, P Godard, JM Godchaux, R Godchaux, G Goegebeur, O Goria, F Gottrand, P Gower, B Grandmaison, M Groux, C Guedon, L Guerbeau, M Gueroult-Dero, JF Guillard, L Guillem, F Guillemot, D Guimberd, B Haddouche, S Hakim, D Hanon, V Hautefeuille, P Heckestweiller, G Hecquet, JP Hedde, H Hellal, PE Henneresse, B Heyman, M Heraud, S Herve, P Hochain, L Houssin-Bailly, P Houcke, B Huguenin, S Iobagiu, S Istanboli, A Ivanovic, I Iwanicki-Caron, E Janicki, M Jarry, J Jeu, JP Joly, C Jonas, A Jouvenet, F Katherin, A Kerleveo, A Khachfe, A Kiriakos, J Kiriakos, O Klein, M Kohut, R Kornhauser, D Koutsomanis, JE Laberenne, E Lacotte, G Laffineur, M Lagarde, A Lalanne, A Lalieu, P Lannoy, J Lapchin, M Laprand, D Laude, R Leblanc, P Lecieux, S Lecleire, N Leclerc, C Le Couteulx, J Ledent, J Lefebvre, P Lefiliatre, C Le Goffic, C Legrand, A Le Grix, P Lelong, B Leluyer, C Lemaitre, C Lenaerts, G Lepeut, L Lepileur, A Leplat, E Lepoutre-Dujardin, H Leroi, MY Leroy, P Le Roy, B Lesage, JP Lesage, X Lesage, J Lesage, I Lescanne-Darchis, J Lescut, D Lescut, B Leurent, P Levy, M Lhermie, L Libier, A Lion, B Lisambert, I Loge, F Loire, J Loreau, S Louf, A Louvet, L Lubret, M Luciani, D Lucidarme, J Lugand, O Macaigne, D Maetz, D Maillard, H Mancheron, O Manolache, AB Marks-Brunel, C Marre, R Marti, F Martin, G Martin, E Marzloff, P Mathurin, J Mauillon, V Maunoury, JL Maupas, MA Medam Djomo, C Mechior, Z Melki, B Mesnard, P Metayer, L Methari, B Meurisse, F Meurisse, L Michaud, X Mirmaran, P Modaine, A Monthe, L Morel, PE Mortier, E Moulin, O Mouterde, N Mozziconaci, J Mudry, M Nachury, MD Ngo, E N’Guyen Khac, B Notteghem, V Ollevier, A Ostyn, A Ouraghi, B Oussadou, D Ouvry, B Paillot, C Painchart, N Panien-Claudot, C Paoletti, A Papazian, B Parent, B Pariente, JC Paris, P Patrier, T Paupard, B Pauwels, M Pauwels, E Penninck, R Petit, M Piat, S Piotte, C Plane, B Plouvier, E Pollet, P Pommelet, D Pop, C Pordes, G Pouchain, P Prades, A Prevost, JC Prevost, G Quartier, B Quesnel, AM Queuniet, JF Quinton, A Rabache, P Rabelle, G Raclot, S Ratajczyk, D Rault, V Razemon, N Reix, T Renaut-Vantroys, M Revillion, G Riachi, C Richez, P Robinson, J Rodriguez, J Roger, JM Roux, A Rudelli, A Saber, G Savoye, P Schlossberg, D Sefrioui, M Segrestin, D Seguy, C Seminur, M Serin, A Seryer, F Sevenet, N Shekh, J Silvie, V Simon, C Spyckerelle, N Talbodec, N Tavernier, H Tchandeu, A Techy, JL Thelu, A Thevenin, H Thiebault, J Thomas, JM Thorel, C Thuillier, G Tielman, M Tode, J Toisin, J Tonnel, JY Touchais, P Toumelin, Y Touze, JL Tranvouez, C Triplet, N Triki, D Turck, S Uhlen, E Vaillant, C Valmage, D Vanco, N Vandaele-Bertiaux, H Vandamme, E Vanderbecq, E Vander Eecken, P Vandermolen, P Vandevenne, L Vandeville, A Vandewalle, C Vandewalle, P Vaneslander, JP Vanhoove, A Vanrenterghem, C Vanveuren, P Varlet, I Vasies, G Verbiese, J Verlynde, G Vernier-Massouille, P Vermelle, C Verne, P Vezilier-Cocq, B Vigneron, M Vincendet, J Viot, YM Voiment, A Wacrenier, L Waeghemaecker, JY Wallez, M Wantiez, F Wartel, J Weber, JL Willocquet, N Wizla, E Wolschies, O Zaharia, S Zaoui, A Zalar, B Zaouri, A Zellweger, C. Ziade

¹ Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR1073, “Nutrition, Inflammation and microbiota-gut-brain axis”, CHU Rouen, Department of Gastroenterology, F-76000 Rouen, France

² Department of Public Health, Epidemiology, and Economic Health, EPIMAD Registry, Regional House of Clinical Research, Lille University Hospital, Lille, France

³ Univ. Lille, INSERM, CHU Lille, U1286 - INFINITE – Institute for Translational Research in Inflammation, F-59000 Lille, France

⁴ Department of Paediatrics, Gastroenterology, Caen University Hospital, Caen, France

⁵ CHU Lille, Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, F-59000 Lille, France

⁶ Department of Paediatrics, Le Havre Hospital, Le Havre, France

⁷ Lille University Hospital, Gastroenterology, Lille, France

⁸ Research and Public Health Unit, Reims University Hospital, Reims, France

⁹ Gastroenterology Unit, Amiens university Hospital, Amiens, France

^⁎ Corresponding author: Nicolas Richard, CHU de Rouen, Service d’Hépato-Gastroentérologie, 37 boulevard Gambetta, 76031 Rouen, France, Tel.: (+33) 02 32 88 67 07, Fax: (+33) 02 32 88 83 56 CHU de Rouen, Service d’Hépato-Gastroentérologie 37 boulevard Gambetta Rouen 76031 France

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Highlights

•	In this cohort of paediatric onset Crohn's disease, one in twenty patients developed a colonic stricture within 10 years of diagnosis .
•	Patients having long-standing active colonic disease are at the highest risk.
•	Colon cancer is infrequent, occurring in one patient (2%) within a few months after the diagnosis of colonic stricture.
•	A conservative management approach for passable colonic strictures in CD patients is possible, provided that a thorough endoscopic evaluation with biopsies, as recommended by ECCO guidelines, has been performed and the patient is at low risk for CRC.

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Abstract

Background

The identification of a colonic stricture in patients with Crohn's disease (CD) often leads to surgery due to concerns about colorectal cancer (CRC) risk. However, data on the risk associated with colonic strictures remain limited, particularly in paediatric-onset CD.

Objectives

To evaluate the incidence of colonic stricture in CD and describe its natural course, focusing specifically on the risk of CRC.

Design

All patients diagnosed with CD <17y between 1988 and 2011, included in a population-based registry, were retrospectively followed until 2013.

Methods

Colonic stricture was defined as digestive lumen narrowing observed on endoscopic or radiological examination. Risk factors for colonic stricture were explored using uni- and multivariable Cox proportional hazards models with time-dependent variables.

Results

A total of 1,007 patients diagnosed with CD between 1988 and 2011 were included. Median follow-up period was 8.8 years. Colonic stricture was diagnosed in 52 patients (5.1%), including 11 at CD diagnosis. Strictures were non-passable by the scope in 31% (n=16) and 14% (n=7) were symptomatic. The cumulative incidence of colonic stricture in CD was 2.9% [95% confidence interval (CI): 1.8%-4.0%] at 5 years. In multivariable analysis, risk of colonic stricture was associated with periods of active disease (HR=2.6 [1.4-4.9], p<0.01), absence of colonic involvement at diagnosis (HR=0.2 [0.0-0.8], p<0.05) and treatment with aminosalicylates (HR=0.4 [0.2-0.8], p<0.05). Stricture related colonic resection and endoscopic balloon dilation were needed in 23% (n=12) and 6% (n=3) of patients, respectively. After a median follow-up of 13.4 years, CRC was detected in one patient (2%) within 6 months after the diagnosis of colonic stricture.