Clinical Trials Study
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World J Gastroenterol. Aug 14, 2014; 20(30): 10570-10576
Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10570
Preoperative colonoscopy through the colonic stent in patients with colorectal cancer obstruction
Jin Su Kim, Kang Moon Lee, Sang Woo Kim, Eun Jung Kim, Chul Hyun Lim, Seong Taek Oh, Myung Gyu Choi, Kyu Yong Choi
Jin Su Kim, Kang Moon Lee, Sang Woo Kim, Eun Jung Kim, Chul Hyun Lim, Seong Taek Oh, Myung Gyu Choi, Kyu Yong Choi, Division of Gastroenterology, Department of Internal Medicine, Catholic University of Korea College of Medicine, Seoul 137-701, South Korea
Seong Taek Oh, Department of surgery, Catholic University of Korea College of Medicine, Seoul 137-701, South Korea
Author contributions: Kim JS and Lee KM are first coauthors, mainly performed study and wrote the paper and equally contributed to this study as first authors; Oh ST, Choi MG and Choi KY designed study and revised manuscript; Kim SW, Kim EJ and Lim CH analyzed data.
Supported by Catholic Research Coordinating Center of the Korea Health 21 RD Project, Ministry of Health and Welfare, South Korea, No. A070001
Correspondence to: Sang Woo Kim, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Catholic University of Korea College of Medicine, Seoul St. Mary’s Hospital, 505 Banpo-Dong, Seocho-Gu, Seoul 137-701, South Korea. viper@catholic.ac.kr
Telephone: +82-2-22586021 Fax: +82-2-22582055
Received: January 1, 2014
Revised: April 6, 2014
Accepted: May 19, 2014
Published online: August 14, 2014
Processing time: 228 Days and 18.1 Hours
Abstract

AIM: To evaluate the feasibility of a preoperative colonoscopy through a self-expendable metallic stent (SEMS) and to identify the factors that affect complete colonoscopy.

METHODS: A total of 48 patients who had SEMS placement because of acute malignant colonic obstruction underwent preoperative colonoscopy. After effective SEMS placement, patients who showed complete resolution of radiological findings and clinical signs of acute colon obstruction underwent a standard bowel preparation. Preoperative colonoscopy was then performed using a standard colonoscope. If the passage of colonoscope was not feasible gastroscope was used. After colonoscopy, cecal intubation time, grade of bowel preparation, tumor location, stent location, presence of synchronous polyps or cancer, damage to colonoscopy and bleeding, and stent migration after colonoscopy were recorded.

RESULTS: Complete evaluation with colonoscope was possible in 30 patients (62.5%). In this group, adenoma was detected in 13 patients (43.3%). The factors that affected complete colonoscopy were also analyzed: Tumor location at an angle; stent placement at an angle; and stent expansion diameter, which affected complete colonoscopy significantly. However in multivariate analysis, stent expansion diameter was the only significant factor that affected complete colonoscopy. Complete evaluation using additional gastroscope was feasible in 42 patients (87.5%).

CONCLUSION: Preoperative colonoscopy through the colonic stent using only conventional colonoscope was unfavorable. The narrow expansion diameter of the stent may predict unfavorable outcome. In such a case, using small caliber scope should be considered and may expect successful outcome.

Keywords: Colon cancer; Stent; Preoperative colonoscopy; Complete colonoscopy

Core tip: The assessment of synchronous neoplasm in acute malignant colonic obstruction remains troublesome. In this study, complete colonoscopy through the colonic stent using colonoscope and gastroscope was feasible in 42 patients (87.5%) and the stent expansion diameter was the only significant factor that affected complete colonoscopy. Through this, we might predict the favorable condition regarding preoperative colonoscopy.