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  • Title: Preoperative colonoscopy after self-expandable metallic stent placement in patients with acute neoplastic colon obstruction.
    Author: Vitale MA, Villotti G, d'Alba L, Frontespezi S, Iacopini F, Iacopini G.
    Journal: Gastrointest Endosc; 2006 May; 63(6):814-9. PubMed ID: 16650544.
    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.
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