Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea.
Gut Liver. 2013 May;7(3):311-6. doi: 10.5009/gnl.2013.7.3.311. Epub 2013 May 13.
BACKGROUND/AIMS: In patients with occlusive colorectal cancers, a complete preoperative evaluation of the colon proximal to the obstruction is often impossible. We aimed to evaluate the feasibility of preoperative colonoscopy after stent placement and to determine whether the success rate of colonoscopy differs between covered and uncovered stents.
Seventy-three patients with malignant colorectal obstruction were enrolled prospectively. In patients with a resectable cancer, a preoperative colonoscopy was performed after insertion of a self-expandable metal stent (SEMS). The success rate of complete preoperative colonoscopy was compared between covered and uncovered stents.
Forty-five of 73 patients who underwent stent placement had a resectable cancer (61.6%). A complete preoperative colonoscopy was possible in 40 of 45 patients (88.9%). The success rate of complete preoperative colonoscopy was significantly lower in the covered-stent group when the obstructing mass lesion was located in the sigmoid colon (p=0.024). Synchronous cancer was detected in one patient (2.2%). Stent migration was observed in four patients with a covered stent.
A preoperative complete colonoscopy after SEMS placement was feasible and safe in most patients with malignant colorectal obstruction. Uncovered stents seem to have more advantages than covered stents in preoperative colonoscopy proximal to the obstruction.
背景/目的：在阻塞性结直肠癌患者中，通常无法对梗阻近端的结肠进行完整的术前评估。我们旨在评估支架置入后进行术前结肠镜检查的可行性，并确定覆盖支架和未覆盖支架的结肠镜检查成功率是否存在差异。
前瞻性纳入 73 例恶性结直肠梗阻患者。对于可切除的癌症患者，在插入自膨式金属支架（SEMS）后进行术前结肠镜检查。比较覆盖支架和未覆盖支架之间完全术前结肠镜检查的成功率。
73 例接受支架置入的患者中有 45 例（61.6%）患有可切除的癌症。45 例可切除癌症患者中有 40 例（88.9%）可进行完全术前结肠镜检查。当梗阻性肿块位于乙状结肠时，覆盖支架组完全术前结肠镜检查的成功率显著较低（p=0.024）。一名患者（2.2%）检测到同步癌。有 4 例覆盖支架的患者出现支架迁移。
在大多数恶性结直肠梗阻患者中，SEMS 放置后进行术前完整结肠镜检查是可行且安全的。在梗阻近端的术前结肠镜检查中，未覆盖支架似乎比覆盖支架具有更多优势。
