Clinical Factors Associated with Successful Total Colonoscopy After Self-Expandable Metallic Stent Placement as Bridge-to-Surgery in Obstructive Colorectal Cancer Patients

Colonic self-expandable metallic stents (SEMSs) are frequently used in patients with obstructive colorectal cancer (CRC) to enable preoperative total colonoscopy (TCS). However, factors influencing TCS success and the potential risks of complications like perforation remain uncertain. This study retrospectively analyzed 48 CRC patients who underwent SEMS placement as a bridge to surgery between 2017 and 2023., focusing on tumor (location, stenosis length, invasion depth) and procedural factors (timing of TCS, stent size, colonoscope type) influencing TCS outcomes. The median patient age was 72 years, with 71% male. Clinical success was defined by successful TCS completion, even with changes in endoscopist or scope. TCS was successful in 77% of cases, with multivariate analysis indicating that deeper tumor invasion (T4) significantly impacted TCS failure. Smaller-diameter scopes were associated with higher success rates, especially in cases of advanced tumor invasion. Synchronous cancers were detected in 10% of the cases. These findings highlight tumor depth as a primary factor in TCS success and suggest smaller scopes may improve outcomes.