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Predictive factors for malignancy in undiagnosed isolated small bowel strictures
Ujjwal Sonika1, Sujeet Saha2, Saurabh Kedia1
1Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Intestinal Research
|November 17, 2017
Summary
Malignancy caused 16% of small bowel strictures, particularly in older patients with single, proximal strictures. Surgical resection is often necessary due to varied etiologies and lack of pre-operative diagnosis.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Small bowel strictures present diverse etiologies, including malignancy.
- Limited data exist on demographic profiles and causes of small bowel strictures in patients undergoing surgery without a definitive pre-operative diagnosis.
Purpose of the Study:
- To analyze the demographic profiles and etiologies of small bowel strictures in surgically treated patients without a definitive pre-operative diagnosis.
- To differentiate between intestinal tuberculosis (ITB) and Crohn's disease (CD), and between malignant and benign strictures.
Main Methods:
- Retrospective analysis of 89 patients operated for small bowel strictures between 2000 and 2014.
- Extracted demographic, imaging, endoscopic, and histological data.
- Conducted univariate and multivariate analyses to identify differentiating factors.
Main Results:
- Intestinal tuberculosis (26.9%) and Crohn's disease (23.5%) were the most common benign causes.
- Malignancy accounted for 15.5% of strictures, with affected patients being older (mean 47.6 years) and often presenting with a single, proximal stricture.
- Age over 50 years showed 80% specificity for malignant etiology; diarrhea predicted CD over ITB.
Conclusions:
- Malignancy is a significant cause of small bowel strictures, especially in older individuals with solitary, proximal lesions.
- Empirical therapy should be avoided, and surgical resection considered promptly for suspected malignant strictures.
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