Preoperative colonoscopy through the colonic stent in patients with colorectal cancer obstruction

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.

Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use

BACKGROUND Ulcerative colitis(UC)is an uncommon inflammatory bowel disease(IBD).However,its incidence has recently increased in South Korea.Moreover,UC diagnoses are frequently delayed,and the relationship between diagnostic delay and UC prognosis has not been extensively studied in South Korean patients.AIM To identify meaningful diagnostic delay affecting UC prognosis and to evaluate risk factors associated with diagnostic delay in South Korean patients.METHODS Medical records of 718 patients with UC who visited the outpatient clinic of six university hospitals in South Korea were reviewed;167 cases were excluded because the first symptom date was unknown.We evaluated the relationship between the prognosis and a diagnostic delay of 3,6,12,18,and 24 mo by comparing the prognostic factors[anti-tumor necrosis factor(TNF)-αuse,admission history due to acute flare-ups,frequent admission due to flare-ups,surgery associated with UC,and the clinical remission state at the latest followup]at each diagnostic interval.RESULTS The mean diagnostic interval was 223.3±483.2 d(median,69 d;75th percentile,195 d).Among the prognostic factors,anti-TNFαuse was significantly increased after a diagnostic delay of 24 mo.Clinical risk factors predictive of a 24-mo diagnostic delay were age<60 years at diagnosis[odd ratio(OR)=14.778,95%confidence interval(CI):1.731-126.121],smoking history(OR=2.688,95%CI:1.239-5.747,P=0.012),and misdiagnosis of hemorrhoids(OR=11.066,95%CI:3.596-34.053).Anti-TNFαuse was associated with extensive UC at diagnosis(OR=3.768,95%CI:1.860-7.632)and 24-mo diagnostic delay(OR=2.599,95%CI:1.006-4.916).CONCLUSION A diagnostic delay>24 mo was associated with increased anti-TNFαuse.Age<60 years at diagnosis,smoking history,and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.