Ultrathin colonoscopy can improve complete preoperative colonoscopy for stenotic colorectal cancer: Prospective observational study

Abstract

Objectives: Preoperative colonoscopy is often incomplete for stenotic colorectal cancers (CRC). This prospective observational study aimed to evaluate the ability of an ultrathin colonoscope (UTC) to inspect the whole colon by passing through the stenotic CRC.Methods: All patients who underwent preoperative colonoscopy for stenotic CRCs at Shizuoka Cancer Center were examined for eligibility. If a standard colonoscope (PCF-H290ZI) could not pass because of a stenosis, the patients were recruited. All of the eligible patients were prospectively enrolled when informed consent could be obtained, and complete colonoscopy was attempted again using an UTC (PCF-PQ260L). Patients with stent placement and those requiring right hemicolectomy were not recruited. Primary endpoints were pass-through and cecal intubation rates. The detected synchronous neoplasias (adenomas and cancers) and their pathological findings after resection were evaluated.Results: A total of 100 patients were enrolled between September 2017 and February 2019. The mean age was 65.6 AE 10.8 years, and 59% were male. The pass-through and cecal intubation rates were 67% (67/100) and 58% (58/100), respectively. Synchronous lesions located proximal to the stenoses were detected in 65.5% (38/58) of the complete colonoscopies, with a total of 86 lesions, including 18 advanced neoplasias with three invasive cancers. Conclusion:When standard colonoscopy cannot pass through stenotic CRC, ultrathin colonoscopy can be considered as an option to inspect the whole colon proximal to the stenosis because treatment strategy can potentially be changed by detecting synchronous neoplasias proximal to the stenosis before surgery. (UMIN000028505)

Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines

“… 191 , 192 Therefore, all patients should undergo a complete colonoscopy exam before surgery if feasible. 193 Alternatively, colonoscopy should be performed intraoperatively or 3–6 months after recovery from surgery to exclude synchronous lesions.…”

Virtual colonoscopy and fibrocolonoscopy in colorectal cancer patients

“…Ултратънък колоноскоп е използван предоперативно при 100 болни, 59 мъже и 41 жени, на средна възраст от 65,6±10,8 г., със стенозиращ КРР през периода между септември 2017 г. и февруари 2019 г. (8). Преминаване на колоноскопа е налице при 67%, а достигане на цекума -при 58% от случаите.…”

Especially thin laser colonoscope enabled precutting endoscopic mucosal resection for proximal T1 cancer in a case of stenotic rectal cancer

“…Generally, stenotic advanced rectal cancer is surgically treated without total colonoscopy (TCS) and synchronous cancers in the proximal colon are not examined. A previous report showed that an ultrathin colonoscope could pass through stenotic cancers and detect other proximal lesions though it didn’t have a high‐resolution image 1 . Recently, an especially thin and high‐resolution laser colonoscope (EC‐L600XP7/L: Fujifilm, Tokyo, Japan), of 9.2 mm in diameter was released in Japan (Fig 1).…”