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Principles of Colonoscopy for Colorectal Cancer Emergency

  • Federica Gaiani
  • Franca Patrizi
  • Iradj Sobhani
  • Gian Luigi de’Angelis
Chapter
Part of the Hot Topics in Acute Care Surgery and Trauma book series (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.

Keywords

Colonoscopy Colorectal cancer Bleeding Obstruction Endoscopic hemostasis Self-expanding metallic stent 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Federica Gaiani
    • 1
  • Franca Patrizi
    • 2
  • Iradj Sobhani
    • 3
  • Gian Luigi de’Angelis
    • 1
  1. 1.Gastroenterology and Endoscopy Unit, University Hospital of ParmaUniversity of ParmaParmaItaly
  2. 2.Gastroenterology and Interventional Endoscopy UnitAUSL BolognaBolognaItaly
  3. 3.Gastroenterology Department, Henri Mondor HospitalUniversity Paris-Est CRETEIL (UPEC)CreteilFrance

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