Related Experiment Video
Updated: Jun 14, 2026

Structured Approach to Colonoscopy Technique Optimization: A Single-Center Experience with Novice Endoscopists
Published on: July 11, 2025
Endoscopic balloon dilation for obstructive colorectal cancer: a basic study on morphologic and pathologic features
Akira Tanaka1, Sotaro Sadahiro, Masanori Yasuda
1Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan. atanaka@is.icc.u-tokai.ac.jp
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.
Related Concept Videos
Endoscopic Procedures II: Colonoscopy
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Esophageal Perforation-I: Introduction
The location of esophageal perforation can vary, occurring anywhere along the esophagus.
Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
Intestinal Obstruction II: Pathophysiology
Diverticular Disease of the Colon
