Gastrointestinal endoscopy · 2010
Endoscopic balloon dilation for obstructive colorectal cancer: a basic study on morphologic and pathologic features associated with perforation.
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Tanaka Akira, Sadahiro Sotaro, Yasuda Masanori, Shimizu Satoru, Maeda Yuji, Suzuki Toshiyuki, Tokunaga Nobuhiro, Ogoshi Kyoji
Аннотация
BACKGROUND: The use of endoscopic dilation and a self-expandable stent for colorectal cancer (CRC) presenting with a stricture or obstruction, either prior to surgery or as a palliative measure (an alternative to colostomy), causes perforation with relative high incidence (1%-17%).
OBJECTIVE: To experimentally investigate risk factors associated with perforation in excised CRC specimens.
DESIGN: Experimental study.
SETTING: Ex vivo experiment on freshly excised human colon cancer specimens at an academic hospital.
PATIENTS: This study involved 47 patients with strictured CRCs of <15 mm in internal diameter as assessed by a preoperative contrast enema.
INTERVENTION: Immediately after surgical resection, a balloon with a diameter of 18 mm was placed in the stricture. The balloon was inflated slowly with hydrostatic pressure over 1 minute and kept at the maximum diameter for 1 minute.
MAIN OUTCOME MEASUREMENTS: Correlations between macroscopic perforation and 20 items, including morphological and histopathological characteristics.
RESULTS: Perforation occurred in 8 of 47 (17.0%) CRC specimens. Four items showed statistically significant (P < .05) correlations with perforation: peritumoral proliferation of collagen fibers (relative area > or =23.9% in the visual field), annularity of the tumor, severe stricture (<7.9 mm), and fewer residual smooth muscle cells in the muscularis propria, reflecting tumor encroachment. The best predictor of perforation was a combination of severe stricture and pronounced peritumoral proliferation of collagen fibers.
LIMITATIONS: An uncontrolled study with a small number of patients.
CONCLUSION: Histopathological and morphological items associated with a decrease in elastic compliance were more important as predictors of perforation than dilation procedure parameters, such as balloon pressure.
OBJECTIVE: To experimentally investigate risk factors associated with perforation in excised CRC specimens.
DESIGN: Experimental study.
SETTING: Ex vivo experiment on freshly excised human colon cancer specimens at an academic hospital.
PATIENTS: This study involved 47 patients with strictured CRCs of <15 mm in internal diameter as assessed by a preoperative contrast enema.
INTERVENTION: Immediately after surgical resection, a balloon with a diameter of 18 mm was placed in the stricture. The balloon was inflated slowly with hydrostatic pressure over 1 minute and kept at the maximum diameter for 1 minute.
MAIN OUTCOME MEASUREMENTS: Correlations between macroscopic perforation and 20 items, including morphological and histopathological characteristics.
RESULTS: Perforation occurred in 8 of 47 (17.0%) CRC specimens. Four items showed statistically significant (P < .05) correlations with perforation: peritumoral proliferation of collagen fibers (relative area > or =23.9% in the visual field), annularity of the tumor, severe stricture (<7.9 mm), and fewer residual smooth muscle cells in the muscularis propria, reflecting tumor encroachment. The best predictor of perforation was a combination of severe stricture and pronounced peritumoral proliferation of collagen fibers.
LIMITATIONS: An uncontrolled study with a small number of patients.
CONCLUSION: Histopathological and morphological items associated with a decrease in elastic compliance were more important as predictors of perforation than dilation procedure parameters, such as balloon pressure.