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Internal passage

  • Internal passage Figure 1
  • Internal passage Figure 2
  • Internal passage Figure 3

Question

A 75-year-old man is admitted to the hospital with a high-grade small-bowel obstruction secondary to metastatic cecal cancer invading the ileocecal valve (Figure). Which of the following is false regarding endoscopic management of colon cancer?

Colonic stenting is the treatment of choice for patients destined to receive antiangiogenic agents, given faster recovery than surgical resection/diversion. Underwater colonoscopy, when feasible, is preferable to carbon dioxide insufflation, given the risk of perforation from a closed-loop phenomenon between the obstructing lesion and the ileocecal valve. Fluoroscopic placement of colonic stents is preferred to help delineate the stricture length and avoid false passage of a guidewire through the friable obstructing mass. In some occasions, colonic decompression may be unsuccessful despite adequate stent deployment because of extra colonic omental deposits or obstruction of the stent with upstream fecal material.
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A 70-year-old man presents with weight loss, anorexia, and nausea. A CT scan shows a significantly thickened gastric wall. Upper endoscopy and mucosal biopsies are performed from hyperemic, “angry-looking” areas, but malignancy is not discerned. A repeat endoscopy is performed, and the lumen is submerged in water. A specialized stiff cold snare is used to obtain sampling underwater. Histopathologic evaluation also is performed (Figure). Which of the following is true about this condition?
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