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Principles of Colonoscopy for Colorectal Cancer Emergency

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Emergency Surgical Management of Colorectal Cancer

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

Abstract

Approximately 15–30% of colorectal cancer (CRC) patients present as a surgical emergency, the most common causes being obstruction, perforation, or bleeding. Except for the absolute contraindication of perforation, colonoscopy can provide therapeutic solutions in case of bleeding or obstruction.

Although CRC presents more commonly with an occult and limited bleeding, overt bleeding with brisk hemorrhage is common. After stabilization of the patient, endoscopic hemostasis may be attempted. The available techniques include injection therapy, contact thermal therapies, noncontact thermal therapy (argon plasma coagulation), band ligation, mechanical therapy with metallic clips, and spraying of topical hemostatic agents. The best technique is chosen based on the characteristics of bleeding and the endoscopist’s experience.

CRC may present with colonic obstruction in up to 15–20% of cases. Usually, the treatment consists in conventional emergency surgery; nevertheless, endoscopy has to be considered an alternative solution in selected cases for a less invasive, either definitive or temporary treatment. After a multidisciplinary evaluation, the placement of self-expanding metallic stents (SEMS) is the technique of choice for the treatment of malignant obstruction, only in patients with an increased risk of postoperative mortality and symptomatic left-sided colonic obstruction.

SEMS placement is also the technique of choice in case of palliation.

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Author information

Authors and Affiliations

  1. Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy

    Federica Gaiani & Gian Luigi de’Angelis

  2. Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Bologna, Italy

    Franca Patrizi

  3. Gastroenterology Department, Henri Mondor Hospital, University Paris-Est CRETEIL (UPEC), Creteil, France

    Iradj Sobhani

Authors
  1. Federica Gaiani
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  2. Franca Patrizi
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  3. Iradj Sobhani
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  4. Gian Luigi de’Angelis
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Editor information

Editors and Affiliations

  1. Department of General Surgery Unit of Digestive, Minimally Invasive and Robotic Surgery, Henri Mondor Hospital, Créteil, France

    Nicola de'Angelis

  2. Cambridge Colorectal Unit, Cambridge Biomedical Campus, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK

    Salomone Di Saverio

  3. Department of General Surgery Unit of Digestive, Minimally Invasive and Robotic Surgery, Henri Mondor Hospital, Créteil, France

    Francesco Brunetti

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Gaiani, F., Patrizi, F., Sobhani, I., de’Angelis, G.L. (2019). Principles of Colonoscopy for Colorectal Cancer Emergency. In: de'Angelis, N., Di Saverio, S., Brunetti, F. (eds) Emergency Surgical Management of Colorectal Cancer. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-06225-5_6

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  • DOI: https://doi.org/10.1007/978-3-030-06225-5_6

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  • Online ISBN: 978-3-030-06225-5

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