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

Abstract

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.