Preoperative colonoscopy after self-expandable metallic stent placement in patients with acute neoplastic colon obstruction

• Published in: Gastrointestinal endoscopy Vol. 63; no. 6; pp. 814 - 819
• Main Authors: Vitale, Mario A., MD, Villotti, Giuseppe, MD, Lucia d'Alba, MD, Frontespezi, Stefano, MD, Iacopini, Federico, MD, Iacopini, Giampaolo, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.2006; Elsevier
• Subjects: Acute Disease; Adenoma - complications; Adenoma - pathology; Adenoma - surgery; Aged; Aged, 80 and over; Biological and medical sciences; Colonic Diseases - etiology; Colonic Neoplasms - complications; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Colonoscopy - methods; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Intestinal Obstruction - etiology; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Neoplasms, Multiple Primary - diagnosis; Preoperative Care; Prospective Studies; Prosthesis Design; Stents; Human; Acute; Colonoscopy; Gastroenterology; Instrumentation therapy; Colon; Endoscopy; Preoperative; Malignant tumor; Stent
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2005.12.032

Background In patients with colorectal cancer, a preoperative colonoscopy is recommended to exclude synchronous lesions. Unfortunately, between 7% and 29% of patients with colorectal cancer present with acute colonic obstruction, making complete colonoscopy impossible. Objective The aim of our study was to evaluate the feasibility of a preoperative colonoscopy after effective stent placement in patients with acute neoplastic obstruction. Design Single-center prospective study. Setting All examinations were carried out at a tertiary referral center with 24-hour emergency endoscopy service. Patients Fifty-seven patients with acute neoplastic colon obstruction. Interventions Patients who recovered from an acute colon obstruction by an effective stent placement and who had a resectable cancer underwent a preoperative colonoscopy. Main Outcome Measurements Patients with a resectable cancer, complete preoperative colonoscopies, and synchronous lesions rates. Results Self-expandable metallic stents (SEMS) were placed in 50 of 57 patients (87.8%). Thirty-one of 50 patients had a resectable cancer (62%), and a complete preoperative colonoscopy was possible in 29 of 31 patients (93.4%). A synchronous cancer was detected in 3 patients (9.6%), changing the surgical plan. Limitations Seven patients in whom the SEMS placement (12.2%) was unsuccessful underwent an urgent surgical intervention. Nineteen of 50 patients who had stent placement were not eligible for our study because of unresectable cancer. Conclusions Our study indicates that it is feasible in a majority of patients to perform full preoperative colonoscopy after relief of acute colonic obstruction with SEMS before surgical resection.