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Lai Y, Jiang M, Zhang X, Zhang L, Chen Z, Du Y, Wang S, Zhao J, Li Z. Novel endoscopic tattooing dye based on polyvinylpyrrolidone-modified polydopamine nanoparticles for labeling gastrointestinal lesions. J Mater Chem B 2024; 12:9345-9356. [PMID: 39171740 DOI: 10.1039/d4tb01298d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Endoscopic tattooing is a localization technique that is particularly important for identifying gastrointestinal lesions for follow-up and subsequent treatment. However, the dyes currently used for endoscopic tattooing have a short tattooing time, high cost, and many side effects. Herein, we designed and prepared polydopamine (PDA) nanoparticles modified with polyvinylpyrrolidone (PVP) for endoscopic tattooing using a physical encapsulation method. PDA has good stability and high adhesion properties, and its stability was further enhanced after PVP modification. In vitro and in vivo tests demonstrated that PDA/PVP has good biosafety. Endoscopic tattooing with PDA/PVP in a porcine model showed that the dye could be stabilized in the digestive tract for at least 60 days. Furthermore, our research results demonstrated that PDA/PVP has excellent reactive oxygen species (ROS) and reactive nitrogen species (RNS) scavenging ability and can promote wound healing. Overall, the strategy proposed herein will lead to the use of an innovative dye for endoscopic tattooing of gastrointestinal lesions.
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Affiliation(s)
- Yongkang Lai
- Department of Gastroenterology, Shanghai Changhai Hospital, Naval Medical University, Shanghai 200433, China.
- Department of Gastroenterology, Ganzhou People's Hospital, Jiangxi Medical College, Nanchang University, Ganzhou 341000, China
| | - Mengni Jiang
- Department of Gastroenterology, Shanghai Changhai Hospital, Naval Medical University, Shanghai 200433, China.
| | - Xinyuan Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Liang Zhang
- Department of Gastroenterology, Shanghai Changhai Hospital, Naval Medical University, Shanghai 200433, China.
| | - Zheng Chen
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Yiqi Du
- Department of Gastroenterology, Shanghai Institute of Pancreatic Diseases, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China.
| | - Shige Wang
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Jiulong Zhao
- Department of Gastroenterology, Shanghai Changhai Hospital, Naval Medical University, Shanghai 200433, China.
| | - Zhaoshen Li
- Department of Gastroenterology, Shanghai Changhai Hospital, Naval Medical University, Shanghai 200433, China.
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Gul MO, Akcicek M, Iflazoglu N, Corbaci K, Emir CA, Guzel M, Parsak CK. Diagnostic Benefits and Surgical Implications of Methods for Tumor Localization in Sigmoid and Rectum Tumors. Diagnostics (Basel) 2024; 14:1363. [PMID: 39001253 PMCID: PMC11240799 DOI: 10.3390/diagnostics14131363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
(1) Background: In our study, we aimed to determine the accuracy rates of imaging methods for sigmoid, rectosigmoid colon, and rectum cancer. (2) Methods: Patients with tumors located in the rectosigmoid colon, sigmoid colon, and rectum who were operated on were included. Upon admission, we examined the patients' first diagnostic colonoscopies and their preoperative repeat control colonoscopies and computed tomography (CT) report. (3) Results: In this study, 23 patients (57.5%) were male. The overall accuracy rates were 80.0% (32/40) in colonoscopy, 65.0% (26/40) in preoperative CT, and 87.5% (35/40) in retro CT, and the differences among the examination methods were statistically significant (p = 0.049). The sensitivity levels decreased to 50.0% for colonoscopy and preoperative CT and 75.0% for retro CT in rectosigmoid colon tumors. In rectal tumors, the sensitivity levels were 75.0% in colonoscopy, 60.0% in preoperative CT, and 80.0% in retro CT. In two patients, the tumor location was given incorrectly, and postoperative pathological evaluations indicated T3N0 tumors; the initially planned treatment was thus changed to include radiotherapy in addition to chemotherapy in the postoperative period because the tumor was located in the middle rectum. (4) Conclusions: Accuracy in tumor localization in sigmoid, rectosigmoid, and rectum tumors still needs to be improved, which could be accomplished with prospective studies. CT evaluations for cancer localization in this patient group should be re-evaluated by a radiologist.
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Affiliation(s)
- Mehmet Onur Gul
- Surgical Oncology Clinic, Malatya Training Research Hospital, 44000 Malatya, Turkey;
| | - Mehmet Akcicek
- Faculty of Medicine, Department of Radiology, Malatya Turgut Özal University, 44000 Malatya, Turkey;
| | - Nidal Iflazoglu
- Surgical Oncology Clinic, Bursa City Hospital, 16110 Bursa, Turkey;
| | - Kadir Corbaci
- General Surgery, Osmaneli Mustafa Selahattin Çetintaş State Hospital, 11500 Bilecik, Turkey;
| | - Cuma Ali Emir
- Surgical Oncology Clinic, Malatya Training Research Hospital, 44000 Malatya, Turkey;
| | - Mehmet Guzel
- Gastroenterology Surgery, Malatya Training Research Hospital, 44000 Malatya, Turkey;
| | - Cem Kaan Parsak
- Faculty of Medicine, Department of Surgical Oncology, Cukurova University, 01330 Adana, Turkey;
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Johnson GGRJ, Vergis A, Singh H, Park J, Warriach A, Helewa RM. Recommendations for Optimal Endoscopic Localization of Colorectal Neoplasms: A Delphi Consensus of National Experts. Dis Colon Rectum 2023; 66:1118-1131. [PMID: 36538707 DOI: 10.1097/dcr.0000000000002441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colonoscopy is the standard of care for diagnosis and evaluation of colorectal cancers before surgery. However, varied practices and heterogenous documentation affects communication between endoscopists and operating surgeons, hampering surgical planning. OBJECTIVE This study aimed to develop recommendations for the use of standardized localization and reporting practices for colorectal lesions identified during lower GI endoscopy. DESIGN A systematic review of existing endoscopy guidelines and thorough narrative review of the overall endoscopy literature were performed to identify existing practices recommended globally. SETTING An online Delphi process was used to establish consensus recommendations based on a literature review. PATIENTS Colorectal surgeons and gastroenterologists from across Canada who had previously demonstrated leadership in endoscopy, managed large endoscopy programs, produced high-impact publications in the field of endoscopy, or participated in the development of endoscopy guidelines were selected to participate. PRIMARY OUTCOME MEASURES The primary outcomes measured were colorectal lesion localization and documentation practice recommendations important to planning surgical or advanced endoscopic excisions. RESULTS A total of 129 of 197 statements achieved consensus after 3 rounds of voting by 23 experts from across Canada. There was more than 90% participation in each round. Recommendations varied according to lesion location in the cecum, colon, or rectum and whether the referral was planned for surgical or advanced endoscopic resection. Recommendations were provided for appropriate documentation, indications, location, and method of tattoo placement, in addition to photograph and real-time 3-dimensional scope configuration device use. LIMITATIONS Because of a paucity of evidence, recommendations are based primarily on expert opinion. There may be bias, as all representatives were based in Canada. CONCLUSIONS Best practices to optimize endoscopic lesion localization and communication are not addressed in previous guidelines. This consensus involving national experts in colorectal surgery and gastroenterology provides a framework for efficient and effective colorectal lesion localization. See Video Abstract at http://links.lww.com/DCR/C71 . RECOMENDACIONES PARA LA LOCALIZACIN ENDOSCPICA PTIMA DE LAS NEOPLASIAS COLORRECTALES UN CONSENSO DELPHI DE EXPERTOS NACIONALES ANTECEDENTES:La colonoscopia es el estándar de atención para el diagnóstico y la evaluación de los cánceres colorrectales antes de la cirugía. Sin embargo, las prácticas variadas y la documentación heterogénea afectan la comunicación entre los endoscopistas y los cirujanos operadores, lo que dificulta la planificación quirúrgica.OBJETIVO:Este estudio tuvo como objetivo desarrollar recomendaciones para el uso de prácticas estandarizadas de localización y notificación de lesiones colorrectales identificadas en la endoscopia gastrointestinal inferior.DISEÑO:Se realizó una revisión sistemática de las pautas de endoscopia existentes y una revisión narrativa exhaustiva de la literatura general sobre endoscopia para identificar las prácticas existentes recomendadas a nivel mundial. Se utilizó un proceso Delphi en línea para establecer recomendaciones de consenso basadas en la revisión de la literatura.PARTICIPANTES:Se seleccionaron para participar cirujanos colorrectales y gastroenterólogos de todo Canadá que previamente habían demostrado liderazgo en endoscopia, manejado grandes programas de endoscopia, producido publicaciones de alto impacto en el campo de la endoscopia o que habían participado en el desarrollo de pautas de endoscopia.RESULTADOS:Localización de lesiones colorrectales y recomendaciones prácticas de documentación importantes para planificar escisiones quirúrgicas o endoscópicas avanzadas.RESULTADOS:129 de 197 declaraciones lograron consenso después de tres rondas de votación de 23 expertos de todo Canadá. Hubo >90% de participación en cada ronda. Las recomendaciones variaron según la ubicación de la lesión en el ciego, colon o recto, y si se planificó la derivación para resección quirúrgica o endoscópica avanzada. Se proporcionaron recomendaciones para la documentación adecuada, las indicaciones, la ubicación y el método de colocación del tatuaje, además de la fotografía y el uso del dispositivo de configuración del alcance 3D en tiempo real.LIMITACIONES:Debido a la escasez de evidencia, las recomendaciones se basan principalmente en la opinión de expertos. Puede haber sesgo, ya que los representantes tenían su sede en Canadá.CONCLUSIONES:Las mejores prácticas para optimizar la localización y comunicación de lesiones endoscópicas no se abordan en las guías anteriores. Este consenso que involucra a expertos nacionales en cirugía colorrectal y gastroenterología proporciona un marco para la localización eficiente y efectiva de lesiones colorrectales. Consulte Video Resumen en http://links.lww.com/DCR/C71 . (Traducción-Dr. Mauricio Santamaria ).
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Affiliation(s)
- Garrett G R J Johnson
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Clinician Investigator Program, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashley Vergis
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harminder Singh
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada
| | - Jason Park
- Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ahmed Warriach
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ramzi M Helewa
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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El-Kefraoui C, Johnson G, Singh H, Helewa RM. Optimal endoscopic localization of colorectal neoplasms: a comparison of rural versus urban documentation practices. World J Surg Oncol 2023; 21:115. [PMID: 36978191 PMCID: PMC10052793 DOI: 10.1186/s12957-023-02987-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Colonoscopy is the gold standard for diagnosing colorectal neoplasms. However, colonoscopy is often repeated preoperatively due to non-standard documentation and inconsistent practices by index endoscopists. Repeat endoscopies result in treatment delays and can increase risks of complications. National consensus recommendations were recently developed for optimal endoscopic colorectal lesion localization. We aimed to assess baseline colonoscopy practice differences from the new recommendations with a focus on geographical variability in report quality between urban and rural referral sites. METHODS We performed a retrospective review of patients who underwent elective surgery for colorectal neoplasms at a single institution in Winnipeg between 2007-2020. We compared endoscopy report quality to the national recommendations with charts stratified by endoscopy location. Our primary outcomes were overall report documentation completeness and use of recommended practices. RESULTS One hundred ninety-four patients were included (97 rural, 97 urban). The mean overall compliance with the recommendations for urban endoscopies was marginally better compared to rural endoscopies (50% vs. 48%, p = 0.04). Sixty-eight percent of the reports complied with tattoo indications (72% urban; 63% rural, p = 0.16). On average, reports included 29% of recommended tattoo information (30% urban; 28% rural, p = 0.25) and demonstrated 74% appropriate tattoo technique (70% urban; 81% rural, p = 0.10). Twenty-one percent of reports included photographs of lesions in accordance with the national recommendations (28% urban; 13% rural, p = 0.01). CONCLUSIONS Endoscopists frequently omit recommended practices for optimal colorectal lesion localization. Rural reports miss more recommended information compared to urban reports. Future research is needed to facilitate province-wide high-quality endoscopy reporting for patients regardless of endoscopy location.
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Affiliation(s)
- Charbel El-Kefraoui
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Surgery, Section of General Surgery, University of Manitoba, St. Boniface General Hospital, Z3023-409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Garrett Johnson
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Surgery, Section of General Surgery, University of Manitoba, St. Boniface General Hospital, Z3023-409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada
- Clinician Investigator Program, University of Manitoba, Winnipeg, MB, Canada
| | - Harminder Singh
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Ramzi M Helewa
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Department of Surgery, Section of General Surgery, University of Manitoba, St. Boniface General Hospital, Z3023-409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada.
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Elnaggar M, Pratheepan P, Paramagurunathan B, Colemeadow J, Hussein B, Bashkirova V, Pillai K, Singh L, Chawla M. The Accuracy of Different Modalities Used for Preoperative Primary Tumour Localisation in Operated Colorectal Cancer Patients. Cureus 2023; 15:e36737. [PMID: 37009370 PMCID: PMC10049957 DOI: 10.7759/cureus.36737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
Aim Colonoscopy and computed tomography (CT) scans of the abdomen and pelvis are routine pre-operative assessment tools in colorectal cancer (CRC) patients. There have been some discrepancies regarding the location of cancer when seen by colonoscopy versus CT scan. The purpose of this study was to compare the accuracy of a colonoscopy with a computed tomography (CT) scan of the abdomen and pelvis with contrast, which is done routinely before surgery to localise the exact site of the tumour within the large bowel, whilst comparing both to the operative, gross and histopathology findings of the exact location. Methods A retrospective study was carried out on 165 colorectal cancer patients operated on between January 1, 2010, and December 31, 2014, using electronic hospital records that were reviewed anonymously, comparing the location of cancer within the large bowels as was found on colonoscopy and CT scan of the abdomen and pelvis with contrast, comparing both to post-operative histopathology specimen or intra-operative assessment in cases where no resection of the primary tumour was performed. Results CT and colonoscopy were both accurate in diagnosing 70.5% of cases that had done both investigations pre-operatively. The best results were obtained when the cancer was located in the caecum as confirmed post-operatively; the combined accuracy rate was 100%. CT was accurate, whilst colonoscopy was not in eight (6.2%) cases (all are rectal or sigmoid cancers), and colonoscopy was accurate and CT was not in 12 cases, 10 of them were rectal and two were ascending colonic. Colonoscopy was not performed in 36 (21%) cases for a variety of reasons, including large bowel obstruction or perforation on presentation. In 32 of these cases, CT scan managed to accurately predict the location of cancer (mostly rectal and caecal), and CT scan was inaccurate in 20.6% of cases (34 out of 165), whilst colonoscopy was inaccurate in 13.9% of cases (18 out of 129). Conclusion Colonoscopy is more accurate in localising colorectal cancers than CT scan of the abdomen and pelvis with contrast. CT scan diagnoses regional and distant spread of colorectal cancers such as nodal status, invasion of neighbouring organs and/or peritoneum and the presence of liver metastases, whilst colonoscopy is limited to intraluminal diagnosis but can be both a diagnostic and therapeutic tool, with higher accuracy, in general, in localising colorectal cancers. Both CT scan and colonoscopy were equal in appendicular, caecal, splenic flexure and descending colon cancer localisation accuracy.
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Sparks R, Power S, Kearns E, Clarke A, Mohan HM, Brannigan A, Mulsow J, Shields C, Cahill RA. Fallibility of tattooing colonic neoplasia ahead of laparoscopic resection: a retrospective cohort study. Ann R Coll Surg Engl 2023; 105:126-131. [PMID: 35175862 PMCID: PMC9889182 DOI: 10.1308/rcsann.2021.0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Precise geographical localisation of colonic neoplasia is a prerequisite for proper laparoscopic oncological resection. Preoperative endoscopic peri-tumoural tattoo practice is routinely recommended but seldom scrutinised. METHODS A retrospective review of recent consecutive patients with preoperative endoscopic lesional tattoo who underwent laparoscopic colonic resection as identified from our prospectively maintained cancer database with supplementary clinical chart and radiological, histological, endoscopic and theatre database/logbook interrogation. RESULTS Some 210 patients with 'tattooed' colonic neoplasia were identified, of whom 169 underwent laparoscopic surgery (mean age 68 years, median BMI 27.8kg/m2, male-to-female ratio 95:74). The majority of tumours were malignant (149; 88%), symptomatic (133; 79%) and proximal to the splenic flexure (92; 54%). Inaccurate colonoscopist localisation judgement occurred in 12% of cases, 60% of which were corrected by preoperative staging computed tomography scan. A useful lesional tattoo was absent in 11/169 cases (6.5%) being specifically stated as present in 104 operation notes (61%) and absent in 10 (5.9%). Tumours missing overt peritumoral tattoos intraoperatively were more likely to be smaller, earlier stage and injected longer preoperatively (p=0.006), although half had histological ink staining. Eight lesions missing tattoos were radiologically occult. Four (44%) of these patients had on-table colonoscopy, and five (55%) needed laparotomy (conversion rate 55% vs 23% overall, p<0.005) with one needing a second operation to resect the initially missed target lesion. Mean (range) operative duration and postoperative length of stay of those missing tattoos compared with those with tattoos was 200 (78-300) versus 188 (50-597) min and 15.5 (4-22) versus 12(4-70) days (p>0.05). CONCLUSIONS Tattoo in advance of attempting laparoscopic resection is vital for precision cancer surgery especially for radiologically unseen tumours to avoid adverse clinical consequence.
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Affiliation(s)
- R Sparks
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - S Power
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - A Clarke
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - A Brannigan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Mulsow
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Shields
- Mater Misericordiae University Hospital, Dublin, Ireland
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Hershorn O, Park J, Singh H, Restall GJ, Clouston KM, Vergis AS, Helewa RM. Variability in Communication and Reporting Practices Between Gastroenterologists and General Surgeons Contributes to Repeat Preoperative Endoscopy for Colorectal Neoplasms: A Qualitative Analysis. Dis Colon Rectum 2023; 66:155-162. [PMID: 34933315 DOI: 10.1097/dcr.0000000000002213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surgeons commonly repeat preoperative endoscopy before planned colorectal resections. The reasons for this are not entirely clear, and repeat endoscopy may lead to delays in curative resection, increased costs, and patient discomfort. OBJECTIVE This study aimed to determine practice patterns, localization techniques, and processes of communication undertaken by endoscopy specialists in a high-volume regional health authority. DESIGN This was a qualitative study involving standardized, semi-structured, in-depth interviews that were conducted in person. Data were analyzed using a thematic analysis approach. SETTINGS The study was conducted at Canadian tertiary and community facilities. PARTICIPANTS Ten general surgeons and 10 gastroenterologists were included using a convenience sampling technique. MAIN OUTCOME MEASURES Interview questions were developed to understand the perspectives and practice patterns of endoscopists when approaching patients diagnosed with colorectal lesions requiring surgical resection. The decision-making process to perform a repeat preoperative endoscopy was assessed. RESULTS Three key themes emerged: 1) patterns of communication, 2) feedback, and 3) trust. Thematic analysis revealed that poor communication and ambiguous documentation increased the likelihood of performing repeat preoperative endoscopy. Inconsistencies in tattooing practices and lesion location were important factors. Negative experiences and factors related to interprofessional trust emerged as key contributors to repeat preoperative endoscopy. LIMITATIONS The transferability of findings to health care systems outside Canada may be limited and requires further study. CONCLUSIONS Suboptimal endoscopic reporting contributes to gaps in communication among endoscopists. In addition, lack of consistent feedback and mutual trust may increase the likelihood of performing repeat preoperative lower endoscopy. Inconsistent tattooing practices pose significant concerns for accurate intraoperative lesion localization. Establishing collaborative work environments through joint educational initiatives may enhance communication and mitigate unnecessary repeat procedures. These results support the need for standardized guidelines and endoscopic reporting in the management of colorectal lesions. See Video Abstract at http://links.lww.com/DCR/B879 . LA VARIABILIDAD EN LAS PRCTICAS DE COMUNICACIN Y PRESENTACIN DE INFORMES ENTRE GASTROENTERLOGOS Y CIRUJANOS GENERALES CONTRIBUYE A REPETIR LA ENDOSCOPIA PREOPERATORIA PARA LAS NEOPLASIAS COLORRECTALES UN ANLISIS CUALITATIVO ANTECEDENTES:Los cirujanos suelen repetir la endoscopia preoperatoria antes de las resecciones colorrectales planificadas. Las razones de esto no están del todo claras y la repetición de la endoscopia puede provocar retrasos en la resección curativa, aumento de los costos y malestar del paciente.OBJETIVO:Nuestro objetivo fue determinar patrones de práctica, técnicas de localización y procesos de comunicación realizados por especialistas en endoscopia, en una autoridad sanitaria regional, de alto volumen.DISEÑO:Este fue un estudio cualitativo, que involucró entrevistas estandarizadas, semiestructuradas y en profundidad que se llevaron a cabo en persona. Los datos se analizaron mediante un enfoque de análisis temático.ENTORNO CLINICO:El estudio se llevó a cabo en instalaciones comunitarias y terciarias canadienses.PARTICIPANTES:Se incluyeron 10 cirujanos generales y 10 gastroenterólogos, utilizando una técnica de muestreo por conveniencia.PRINCIPALES MEDIDAS DE VALORACION:Las preguntas de la entrevista se desarrollaron para comprender las perspectivas y los patrones de práctica de los endoscopistas, cuando se acercan a pacientes diagnosticados con lesiones colorrectales que requieren resección quirúrgica. Se evaluó el proceso de toma de decisiones para realizar una nueva endoscopia preoperatoria.RESULTADOS:Surgieron tres temas clave: 1) patrones de comunicación, 2) retroalimentación y 3) confianza. El análisis temático reveló que la pobre comunicación y la ambigua documentación aumentaron la probabilidad de realizar una nueva endoscopia preoperatoria. Las inconsistencias en las prácticas de tatuaje y la ubicación de las lesiones fueron factores importantes. Las experiencias pasadas negativas y los factores relacionados con la confianza interprofesional surgieron como contribuyentes clave para repetir la endoscopia preoperatoria.LIMITACIONES:La transferibilidad de los hallazgos a los sistemas de atención médica fuera de Canadá, puede ser limitada y requiere más estudios.CONCLUSIONES:Los informes endoscópicos subóptimos contribuyen a las brechas en la comunicación entre los endoscopistas. Además, la falta de retroalimentación consistente y la confianza mutua pueden aumentar la probabilidad de realizar una nueva endoscopia baja preoperatoria. Las prácticas inconsistentes de tatuaje, plantean preocupaciones importantes para la localización precisa de las lesiones intraoperatorias. El establecimiento de entornos de trabajo colaborativo a través de iniciativas educativas conjuntas pueden mejorar la comunicación y mitigar la repetición de procedimientos innecesarios. Estos resultados apoyan la necesidad de pautas estandarizadas e informes endoscópicos en el tratamiento de las lesiones colorrectales. Consulte Video Resumen en http://links.lww.com/DCR/B879 . (Traducción-Dr. Fidel Ruiz Healy ).
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Affiliation(s)
- Olivia Hershorn
- Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason Park
- Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harminder Singh
- Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gayle J Restall
- Department of Occupational Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kathleen M Clouston
- Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashley S Vergis
- Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ramzi M Helewa
- Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Hershorn O, Park J, Singh H, Clouston K, Vergis A, Helewa RM. Rates and predictors of repeat preoperative endoscopy for elective colorectal resections: how can we avoid repeated procedures? Surg Endosc 2022; 36:4115-4123. [PMID: 34559258 DOI: 10.1007/s00464-021-08733-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/06/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Despite limited endoscopy resources, repeat endoscopy prior to surgery is commonly practised. Our aim was to determine repeat preoperative endoscopy rates and factors influencing this practice at a high-volume Canadian tertiary centre. METHOD A retrospective cohort study was conducted on all patients undergoing elective colorectal resections for benign and malignant neoplasms at a tertiary centre in Winnipeg, Canada between 2007 and 2017. Multivariable logistic regression analysis was used to identify predictors of repeat preoperative endoscopy. RESULTS Of 1062 patients identified, mean age was 68 years and 56% were male. Rate of repeat preoperative endoscopy was 29%. On multivariable analysis, male sex (OR 1.68, CI 1.19-2.34, p = 0.003) and lesions located in the left colon (OR 2.73, CI 1.79-4.14, p < 0.001), rectosigmoid (OR 9.11, CI 2.14-38.8, p = 0.003), and rectum (OR 4.06, CI 2.58-6.38, p < 0.001) were at increased odds of undergoing repeat preoperative endoscopy. Patients with a tattoo placed at index endoscopy were at markedly lower odds of undergoing repeat preoperative endoscopy (OR 0.48, CI 0.34-0.68, p < 0.001). Index endoscopist specialty was not a significant predictor of repeat endoscopy (OR 0.76, CI 0.54-1.06, p = 0.09). CONCLUSIONS Repeat preoperative lower endoscopy is commonly practised and may be unnecessary if appropriate identification and documentation of lesions has been achieved. Tattooing of suspicious lesions is a key modifiable factor associated with reduced likelihood of repeat preoperative endoscopy. This study highlights the need for standardized guidelines and endoscopy reporting practices given the delays and costs associated with repeat preoperative endoscopy.
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Affiliation(s)
- Olivia Hershorn
- Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada.
| | - Jason Park
- Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Harminder Singh
- Section of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Kathleen Clouston
- Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Ashley Vergis
- Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Ramzi M Helewa
- Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada.
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Chen MZ, Devan Nair H, Saboo A, Lee SCL, Gu X, Auckloo SMA, Tamang S, Chen SJ, Lowe RW, Strugnell N. A single centre audit: repeat pre-operative colonoscopy. ANZ J Surg 2022; 92:2571-2576. [PMID: 35642258 DOI: 10.1111/ans.17813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/03/2022] [Accepted: 05/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Repeat colonoscopy may be required for tumour localisation. The aim of the study is to explore the clinical settings it was used and benchmark the quality of initial colonoscopy against standardized guidelines for tumour localisation, tattooing and colonoscopy reporting amongst clinicians. METHODS A retrospective study from 2016 to 2021 has been performed on patients who underwent elective colorectal cancer resections at the Northern Hospital. Patient demographics, colonoscopic and operative details were retrieved from the Bi-National Colorectal Cancer Audit (BCCA) Registry database and hospital medical records. PRIMARY OUTCOMES changes in operative approach and delays to operation. SECONDARY OUTCOMES reasons for a repeat colonoscopy and complications from repeat colonoscopy. RESULTS A total of 339 patients were included in this study. 94 (28.6%) underwent a repeat colonoscopy. Re-scoping rate was 29.6% for surgeons, and 26.2% for non-operating endoscopists. Surgeons had a 5.9% localisation error rate, and non-operating endoscopist 6.95% (p = 0.673). Surgeons did not have a lower rate of repeat colonoscopy (p = 0.462). Repeat endoscopy was associated with a longer time to definitive operation (p < 0.001). No complications were associated with a repeat colonoscopy. CONCLUSION There was no difference in localisation error rates or repeat colonoscopy amongst surgeons (29.6%) and non-operating endoscopists (26.2%) (p = 0.462). This could be explained by the standardized endoscopy training in Australia governed by a common training board. Lack of tattooing at index colonoscopy and inadequate documentation often led to a repeat endoscopy, which was associated with a longer time to definitive operation. Standardized guidelines in tattooing of lesions and colonoscopy reporting should be implemented.
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Affiliation(s)
- Michelle Zhiyun Chen
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Hareshdeva Devan Nair
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Apoorva Saboo
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Sharon Chih Lin Lee
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Xinchen Gu
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | | | - Sandeep Tamang
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Sally Jiasi Chen
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Ryan William Lowe
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Neil Strugnell
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Zhang S, Wang Q, Feng Y, Zhang G, Chen Y, Zheng W, Wu X, Yang A. Clip or Tattooing: A Comparative Study for Preoperative Colon Cancer Endoscopic Localization. Front Oncol 2022; 12:846900. [PMID: 35280761 PMCID: PMC8916562 DOI: 10.3389/fonc.2022.846900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Aim Preoperative endoscopic markers have been extensively used for the localization of colonic neoplastic lesions in laparoscopic surgery. We conducted this respective cohort study to compare the localization accuracy of two commonly used endoscopic marker strategies (endoscopic clip plus abdominal plain film and endoscopic tattooing). Methods Patients who received preoperative colonoscopy localization for colonic neoplasia and underwent an elective laparoscopic operation afterward between 2013 and 2020 were included in this retrospective study. The localization accuracy of the two endoscopic strategies was compared, and the predictors of successful endoscopic localization were identified by multivariate regression. Results In total, 195 patients [average age 62.4 ± 9.2 years, 123 male (63.1%)] undergoing preoperative colonoscopy localization and subsequent laparoscopic colectomy for colonic neoplasms were included. Endoscopic localization was finally proven to be successful in 150 (76.9%) patients in the surgery. Compared to the tattooing group, patients who had successful localization for colonic lesions were fewer in the clip group (64 of 101 cases, 63.4% vs. 86 of 94 cases, 91.5%, p < 0.001). The multivariate regression analysis showed that the endoscopic tattooing strategy, endoscopic clip strategy, and lesion location were all predictors for successful localization (all with p < 0.001). Conclusion Compared with endoscopic clip plus abdominal plain film, endoscopic tattooing had higher localization accuracy and less intraoperative colonoscopy counseling; the endoscopic clip strategy, tattooing strategy, and colonic lesion location were all predictors of successful endoscopic localization.
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Affiliation(s)
- Shengyu Zhang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Qiang Wang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yunlu Feng
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Guannan Zhang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yang Chen
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Weiyang Zheng
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xi Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Aiming Yang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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Repeat preoperative endoscopy after regional implementation of electronic synoptic endoscopy reporting: a retrospective comparative study. Surg Endosc 2021; 36:2886-2895. [PMID: 34101014 DOI: 10.1007/s00464-021-08580-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Repeat preoperative endoscopy is common for patients with colorectal neoplasms. This can result in treatment delays, patient discomfort, and risks of colonoscopy-related complications. Repeat preoperative endoscopy has been attributed to poor communication between endoscopists and surgeons. In January 2019, mandatory electronic synoptic reporting for endoscopy was implemented to include elements consistent with quality indicators proposed in national guidelines. The aim of the present study is to assess whether the repeat preoperative endoscopy rate for colorectal lesions changed following synoptic report implementation. METHODS A retrospective review was performed of 1690 consecutive patients who underwent elective surgical resection for colorectal neoplasms from January 2007 to June 2020 at a tertiary hospital in Canada. Patients who had an index endoscopy documented via synoptic report were compared to those reported via narrative report. Primary outcomes were rates of repeat preoperative endoscopy and inclusion of colonoscopy quality indicators: photo-documentation, tattoo placement, and bowel preparation score. RESULTS In total, 1429 patients who underwent elective colorectal resection for colorectal cancers or polyps between January 2007 and June 2020 were included. 115 had index endoscopies recorded via synoptic report and 1314 by narrative report. The repeat preoperative endoscopy rate after endoscopies documented by narrative report was 29.07% (95% CI 26.63-31.61) and 25.22% (95% CI 17.58-34.17%) for synoptic report. Patients whose index endoscopies where performed by a practitioner other than their operating surgeon had a re-endoscopy rate of 36.03% (95% CI 32.82-39.33%) after narrative report and 38.81% (95% CI 27.14-51.50%) for synoptic report. Rates of tattoo placement, photo-documentation, and reporting of bowel preparation quality were all significantly increased with synoptic reports (p ≤ 0.003). CONCLUSIONS Endoscopy synoptic reports based on current guidelines were not associated with a decrease in rates of repeat pre-operative endoscopy at a high-volume colorectal cancer centre. Future study should examine guideline deficiencies for this purpose and make necessary modifications.
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Hershorn O, Park J, Singh H, Clouston K, Vergis A, Helewa RM. Predictors and rates of prior endoscopic tattoo localization amongst individuals undergoing elective colorectal resections for benign and malignant lesions. Surg Endosc 2020; 35:5524-5530. [PMID: 33025255 DOI: 10.1007/s00464-020-08048-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Appropriate tattooing of suspicious lesions during colonoscopy is critical for surgical planning. However, variability exists in tattoo placement, technique, and reporting. Our aim is to determine the rates and predictors of tattoo placement, tattoo location in relation to the lesion, and localization accuracy during lower endoscopy for individuals undergoing elective colorectal resections. METHODS We performed a retrospective chart review on all patients undergoing elective colorectal resections for benign and malignant neoplasms between 2007 and 2017 at a high volume Canadian tertiary centre. Patient demographics, endoscopic, and tumour-related characteristics were collected. Multivariable logistic regression analysis was used to identify predictors of tattoo localization. RESULTS Of the 1062 patients identified, laparoscopic resection occurred in 59% of patients. 57% of patients underwent tattooing for tumour localization at index endoscopy. Tattoos were placed distal (27%), both proximal and distal (4%), and just proximal (2%) to the lesion. However, in the majority of cases the tattoo location was not documented (67%). On multivariate analysis, patients who had lesions located in the transverse colon (OR: 1.93, 95% CI 1.04-3.59), had surgery performed after 2010 (2011-2014: OR: 1.88, 95% CI 1.31-2.68; 2015-2017: OR: 2.87, 95% CI 1.93-4.26), underwent laparoscopic resections (OR: 1.69, 95% CI 1.22-2.33), and had their index endoscopy performed in an urban setting (OR: 5.92, 95% CI 3.23-10.87), were at higher odds of having a tattoo placed at index endoscopy. CONCLUSION Endoscopic tattoo placement and location in relation to the lesion varies widely, with reports containing suboptimal documentation. Lesion location and laparoscopic procedures were significant predictors of tattoo placement. This study highlights the need for standardized tattooing practices and reporting amongst endoscopists. One of the focus of quality improvement efforts should be educational initiatives for rural endoscopists.
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Affiliation(s)
- Olivia Hershorn
- Section of General Surgery, Department of Surgery, University of Manitoba, Tache Avenue, Z3049-409, Winnipeg, MB, R2H 2A6, Canada.
| | - Jason Park
- Section of General Surgery, Department of Surgery, University of Manitoba, Tache Avenue, Z3049-409, Winnipeg, MB, R2H 2A6, Canada
| | - Harminder Singh
- Section of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Kathleen Clouston
- Section of General Surgery, Department of Surgery, University of Manitoba, Tache Avenue, Z3049-409, Winnipeg, MB, R2H 2A6, Canada
| | - Ashley Vergis
- Section of General Surgery, Department of Surgery, University of Manitoba, Tache Avenue, Z3049-409, Winnipeg, MB, R2H 2A6, Canada
| | - Ramzi M Helewa
- Section of General Surgery, Department of Surgery, University of Manitoba, Tache Avenue, Z3049-409, Winnipeg, MB, R2H 2A6, Canada.
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The Usefulness of Preoperative Colonoscopic Tattooing with Autologous Blood for Localization in Laparoscopic Colorectal Surgery. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2020; 23:114-119. [PMID: 35602381 PMCID: PMC8985630 DOI: 10.7602/jmis.2020.23.3.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/18/2020] [Accepted: 08/11/2020] [Indexed: 11/08/2022]
Abstract
Purpose In colorectal cancer surgery, it is important to have accurate resection margins. However, it is challenging to localize lesions during laparoscopy. Therefore, to reduce surgical errors, many preoperative localizing methods have been introduced. In this study, we aimed to assess the preoperative feasibility and safety of autologous blood tattooing. Methods A total of 11 patients underwent preoperative colonoscopic autologous blood tattooing from August 2017 to February 2020. At the start of the surgery, the surgeon assessed the patients for the precision of visibility and other complications such as abscess or spillage. The patients’ characteristics, outcomes, and complications were collected retrospectively. Results The study comprised 8 men and 3 women, with an average age of 63 years. Ten patients showed precise visibility, and no localization errors were observed during surgery. No complication was observed in all patients. Conclusion Preoperative autologous blood tattooing is a very useful and safe technique because it has high visibility with no complications. This method does not require additional agents or facilities. A large-scale study will be required to develop standard guidelines.
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Determination of Tumor Location in Rectosigmoid Carcinomas: Difficulties in Preoperative Diagnostics. GASTROINTESTINAL DISORDERS 2019. [DOI: 10.3390/gidisord1010016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Differentiation between rectal and sigmoid carcinomas is a diagnostic challenge with important implications for further treatment. Depending on the tumor stage, treatment for rectal carcinoma consists of preoperative (chemo)radiotherapy and surgery. Sigmoid carcinomas are treated with surgery alone. We established the diagnostic accuracy of flexible endoscopy, MRI and/or CT scan, and both modalities combined as reflected by the conclusion of our multidisciplinary team (MDT). Furthermore, we assessed the treatment consequences of misdiagnosis. Consecutive patients were included who underwent surgery from January 2012 to January 2017 for colorectal carcinoma located ≤20 cm from the anal verge as determined by flexible colonoscopy. Diagnostic accuracy of MRI/CT, flexible endoscopy and the final MDT conclusion were analyzed as index test. The location of the tumor during surgery and the type of surgery was the reference standard. We included 293 patients. Flexible endoscopy had a diagnostic accuracy of 90% and for MRI/CT scanning this was 86–87%. Combination of both modalities improved diagnostic accuracy to 96%. Due to misdiagnosis during initial staging, three patients (1%) erroneously underwent neoadjuvant treatment and in two patients neoadjuvant treatment was potentially erroneously omitted. In conclusion, the combination of both flexible endoscopy and MRI/CT (the MDT conclusion) improves diagnostic accuracy. Erroneous clinical diagnosis can lead to under- and overtreatment.
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15
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Fernandez LM, Ibrahim RNM, Mizrahi I, DaSilva G, Wexner SD. How accurate is preoperative colonoscopic localization of colonic neoplasia? Surg Endosc 2018; 33:1174-1179. [DOI: 10.1007/s00464-018-6388-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/10/2018] [Indexed: 01/06/2023]
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Diagnostic utility of staging abdominal computerized tomography and repeat endoscopy in detecting localization errors at initial endoscopy in colorectal cancer. Surg Endosc 2018; 32:3303-3310. [PMID: 29362908 DOI: 10.1007/s00464-018-6051-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/11/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Colonoscopy has a reported localization error rate as high as 21% in detecting colorectal neoplasms. Preoperative repeat endoscopy has been shown to be protective against localization errors. There is a paucity of literature assessing the utility of staging computerized tomography (CT) and repeat endoscopy as diagnostic tools for detecting localization errors following initial endoscopy. The objective of this study is to determine the diagnostic characteristics of staging CT and repeat endoscopy in correcting localization errors at initial endoscopy. METHODS A retrospective cohort study was conducted at a large tertiary academic center between January 2006 and August 2014. All patients undergoing surgical resection for CRC were identified. Group comparisons were conducted between (1) patients that underwent only staging CT (staging CT group), and (2) patients that underwent staging CT and repeat endoscopy (repeat endoscopy group). The primary outcome was localization error correction rate for errors at initial endoscopy. RESULTS 594 patients were identified, 196 (33.0%) in the repeat endoscopy group, and 398 (77.0%) patients in the staging CT group. Error rates for each modality were as follows: initial endoscopy 8.8% (95% CI 6.5-11.0), staging CT 9.3% (95% CI 6.5-11.0), and repeat endoscopy 2.6% (95% CI 0.3-4.7); p < 0.01. Repeat endoscopy was superior to staging CT in correcting localization errors for left-sided / rectal lesions (81.2% vs. 33.3%; p < 0.01), right-sided lesions (80.0% vs. 54.5%; p = 0.21), and overall lesions (80.8% vs. 42.3%; p < 0.01). Repeat endoscopy compared to staging CT demonstrated relative risk reduction of 66.7% (95% CI 22-86%), absolute risk reduction of 38.5% (95% CI 14.2-62.8%), and odds ratio of 0.18 (95% CI 0.05-0.61) for correcting errors at initial endoscopy. CONCLUSIONS Repeat endoscopy in colorectal cancer is superior to staging CT as a diagnostic tool for correcting localization-based errors at initial endoscopy.
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Blum-Guzman JP, Wanderley de Melo S. Location of colorectal cancer: colonoscopy versus surgery. Yield of colonoscopy in predicting actual location. Endosc Int Open 2017; 5:E642-E645. [PMID: 28691047 PMCID: PMC5500114 DOI: 10.1055/s-0043-110564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 01/17/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Recent studies suggest that differences in biological characteristics and risk factors across cancer site within the colon and rectum may translate to differences in survival. It can be challenging at times to determine the precise anatomical location of a lesion with a luminal view during colonoscopy. The aim of this study is to determine if there is a significant difference between the location of colorectal cancers described by gastroenterologists in colonoscopies and the actual anatomical location noted on operative and pathology reports after colon surgery. PATIENTS AND METHODS A single-center retrospective analysis of colonoscopies of patient with reported colonic masses from January 2005 to April 2014 (n = 380) was carried. Assessed data included demography, operative and pathology reports. Findings were compared: between the location of colorectal cancers described by gastroenterologists in colonoscopies and the actual anatomical location noted on operative reports or pathology samples. RESULTS We identified 380 colonic masses, 158 were confirmed adenocarcinomas. Of these 123 underwent surgical resection, 27 had to be excluded since no specific location was reported on their operative or pathology report. An absolute difference between endoscopic and surgical location was found in 32 cases (33 %). Of these, 22 (23 %) differed by 1 colonic segment, 8 (8 %) differed by 2 colonic segments and 2 (2 %) differed by 3 colonic segments. CONCLUSION There is a significant difference between the location of colorectal cancers reported by gastroenterologists during endoscopy and the actual anatomical location noted on operative or pathology reports after colon surgery. Endoscopic tattooing should be used when faced with any luminal lesions of interest.
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Affiliation(s)
- Juan Pablo Blum-Guzman
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
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Acuna SA, Elmi M, Shah PS, Coburn NG, Quereshy FA. Preoperative localization of colorectal cancer: a systematic review and meta-analysis. Surg Endosc 2016; 31:2366-2379. [PMID: 27699516 DOI: 10.1007/s00464-016-5236-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/30/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preoperative colorectal tumor localization is crucial for appropriate resection and treatment planning. As the localization accuracy of conventional colonoscopy is considered to be low, several localization techniques have been developed. We systematically reviewed the tumor localization error rates of several preoperative endoscopic techniques and synthesized information on risk factors for localization errors and procedure-related adverse events. METHODS MEDLINE, EMBASE, the Cochrane Library, and the grey literature were searched. Studies were included if they reported tumor localization errors in patients with colorectal cancer undergoing resection with curative intent. Using random-effects models, pooled incidence of tumor localization errors were derived for conventional colonoscopy and colonoscopic tattooing. Due to the lack of comparative studies, a direct comparison of the pooled estimates was performed. Procedure-related adverse events, risk factors for localization errors, and the localization outcomes of other techniques such as colonoscopic clip placement, radioguided occult colonic lesion identification, and the use of magnetic endoscope imaging were also synthesized. RESULTS A total of 38 non-randomized controlled and observational studies were included in this review (2578 patients underwent conventional colonoscopy and 643 colonoscopic tattooing). The pooled incidence of localization errors with conventional colonoscopy was 15.4 % (95 % CI 12.0-18.7), whereas that of colonoscopic tattooing was 9.5 % (95 % CI 5.7-13.3), mean difference 5.9 % (95 % CI 0.65-11.14, p = 0.03). Adverse events secondary to tattooing were infrequent, and most were cases of ink spillage. Limited information was available for other localization techniques. CONCLUSION Conventional colonoscopy has a higher incidence of localization error compared to colonoscopic tattooing for localization of colorectal cancer. Colonoscopic tattooing is safe and leads to fewer tumor localization errors. Given the widespread adoption of laparoscopic resections for colorectal cancer, routine colonoscopic tattooing should be adopted. However, studies directly comparing different localization techniques are needed.
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Affiliation(s)
- Sergio A Acuna
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Maryam Elmi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Prakesh S Shah
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Departments of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Fayez A Quereshy
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of General Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street Main Pavilion, Room 8-320, Toronto, ON, M5T 2S8, Canada.
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Choi WJ, Cleghorn MC, Quereshy FA. Preoperative repeat endoscopy for colorectal cancer: What is its role and when is it necessary? Can J Surg 2016; 59:427-428. [PMID: 27669401 DOI: 10.1503/cjs.005116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
SUMMARY Many surgeons consider repeat endoscopy to be the standard of care for colorectal cancer; however, its utility in the preoperative setting is not well understood, especially given the lack of standardized guidelines on appropriate tumour localization and colonoscopic reporting. This often results in patients undergoing an unnecessary medical procedure during their preoperative evaluation. We discuss some of the issues surrounding the practice of preoperative repeat endoscopy as well as patient perspectives on the procedure. Our observations suggest that repeat endoscopy in the setting of colorectal cancer surgery may play a role in enabling transition of patient care between the initial endoscopist and the treating surgeon and in improving the patient experience. Patients with operable colorectal cancer appear to understand and support the current use of repeat endoscopy. However, improving preoperative care will require further research and ultimately the development of evidence-based clinical guidelines.
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Affiliation(s)
- Woo Jin Choi
- From the Division of General Surgery and Surgical Oncology, University Health Network, Toronto, Ont
| | - Michelle C Cleghorn
- From the Division of General Surgery and Surgical Oncology, University Health Network, Toronto, Ont
| | - Fayez A Quereshy
- From the Division of General Surgery and Surgical Oncology, University Health Network, Toronto, Ont
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20
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A comparison of endoscopic localization error rate between operating surgeons and referring endoscopists in colorectal cancer. Surg Endosc 2016; 31:1318-1326. [DOI: 10.1007/s00464-016-5114-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/12/2016] [Indexed: 12/15/2022]
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Azin A, Jimenez MC, Cleghorn MC, Jackson TD, Okrainec A, Rossos PG, Quereshy FA. Discrepancy between gastroenterologists' and general surgeons' perspectives on repeat endoscopy in colorectal cancer. Can J Surg 2016; 59:29-34. [PMID: 26812406 DOI: 10.1503/cjs.005115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND A myriad of localization options are available to endoscopists for colorectal cancer (CRC); however, little is known about the use of such techniques and their relation to repeat endoscopy before CRC surgery. We examined the localization practices of gastroenterologists and compared their perceptions toward repeat endoscopy to those of general surgeons. METHODS We distributed a survey to practising gastroenterologists through a provincial repository. Univariate analysis was performed using the χ² test. RESULTS Gastroenterologists (n = 69) reported using anatomical landmarks (91.3%), tattooing (82.6%) and image capture (73.9%) for tumour localization. The majority said they would tattoo lesions that could not be removed by colonoscopy (91.3%), high-risk polyps (95.7%) and large lesions (84.1%). They were equally likely to tattoo lesions planned for laparoscopic (91.3%) or open (88.4%) resection. Rectal lesions were less likely to be tattooed (20.3%) than left-sided (89.9%) or right-sided (85.5%) lesions. Only 1.4% agreed that repeat endoscopy is the standard of care, whereas 38.9% (n = 68) of general surgeons agreed (p < 0.001). General surgeons were more likely to agree that an incomplete initial colonoscopy was an indication for repeat endoscopy (p = 0.040). Further, 56% of general surgeons indicated that the findings of repeat endoscopy often lead to changes in the operative plan. CONCLUSION Discrepancies exist between gastroenterologists and general surgeons with regards to perceptions toward repeat endoscopy and its indications. This is especially significant given that repeat endoscopy often leads to change in surgical management. Further research is needed to formulate practice recommendations that guide the use of repeat endoscopy, tattoo localization and quality reporting.
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Affiliation(s)
- Arash Azin
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos)
| | - M Carolina Jimenez
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos)
| | - Michelle C Cleghorn
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos)
| | - Timothy D Jackson
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos)
| | - Allan Okrainec
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos)
| | - Peter G Rossos
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos)
| | - Fayez A Quereshy
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos)
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Tumor Localization for Laparoscopic Colorectal Resection Without Endoscopic Tattooing. Surg Laparosc Endosc Percutan Tech 2016; 26:230-5. [DOI: 10.1097/sle.0000000000000257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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