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

BackgroundIn 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.ObjectiveThe aim of our study was to evaluate the feasibility of a preoperative colonoscopy after effective stent placement in patients with acute neoplastic obstruction.DesignSingle-center prospective study.SettingAll examinations were carried out at a tertiary referral center with 24-hour emergency endoscopy service.PatientsFifty-seven patients with acute neoplastic colon obstruction.InterventionsPatients who recovered from an acute colon obstruction by an effective stent placement and who had a resectable cancer underwent a preoperative colonoscopy.Main Outcome MeasurementsPatients with a resectable cancer, complete preoperative colonoscopies, and synchronous lesions rates.ResultsSelf-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.LimitationsSeven 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.ConclusionsOur 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.