Analysis of lesion localisation at colonoscopy: outcomes from a multi-centre U.K. study

Abstract

BackgroundColonoscopy is currently the gold standard for detection of colorectal lesions, but may be limited in anatomically localising lesions. This audit aimed to determine the accuracy of colonoscopy lesion localisation, any subsequent changes in surgical management and any potentially influencing factors.MethodsPatients undergoing colonoscopy prior to elective curative surgery for colorectal lesion/s were included from 8 registered U.K. sites (2012–2014). Three sets of data were recorded: patient factors (age, sex, BMI, screener vs. symptomatic, previous abdominal surgery); colonoscopy factors (caecal intubation, scope guide used, colonoscopist accreditation) and imaging modality. Lesion localisation was standardised with intra-operative location taken as the gold standard. Changes to surgical management were recorded.Results364 cases were included; majority of lesions were colonic, solitary, malignant and in symptomatic referrals. 82% patients had their lesion/s correctly located at colonoscopy. Pre-operative CT visualised lesion/s in only 73% of cases with a reduction in screening patients (64 vs. 77%; p = 0.008). 5.2% incorrectly located cases at colonoscopy underwent altered surgical management, including conversion to open. Univariate analysis found colonoscopy accreditation, scope guide use, incomplete colonoscopy and previous abdominal surgery significantly influenced lesion localisation. On multi-variate analysis, caecal intubation and scope guide use remained significant (HR 0.35, 0.20–0.60 95% CI and 0.47; 0.25–0.88, respectively).ConclusionLesion localisation at colonoscopy is incorrect in 18% of cases leading to potentially significant surgical management alterations. As part of accreditation, colonoscopists need lesion localisation training and awareness of when inaccuracies can occur.

Diagnostic Yield of Colonoscopy

“…Next, was the rectosigmoid area which had over one fifth of the pathologies recorded. This trend is like findings in a study from the UK which showed a high correlation of colonoscopy pathology site with surgery findings [16].…”

Right-Sided Location Not Associated With Missed Colorectal Adenomas in an Individual-Level Reanalysis of Tandem Colonoscopy Studies

“…CT or even surgery 58,59 ; whether this could be extrapolated to a limited accuracy to define full cecal intubation, is likely, but finally unknown. In any case, we need more long-term follow-up studies from the various screening programmes on either primary screening colonoscopy or stool-based screening programmes to find out whether there is a clear predominance of right sided missed cancers.…”

Endoscopic clips allow for accurate pre‐operative localisation of colorectal cancer

“…Colonoscopy combined with tattoo marking is the current gold standard for diagnosis and pre‐operative localisation of colorectal cancer. However, the accuracy of colonoscopy localisation varies between 59.7% and 98.3% with a recent prospective multi‐centre study reporting an 82% pre‐operative colonoscopy localisation accuracy rate 2 . Inaccurate localisations can alter surgical management, and this is reported to occur in 5.2%–6.3% of cases 2,12,13 .…”

“…The current gold standard for identification and pre‐operative localisation is colonoscopy with tattoo marking. However, colonoscopy inaccurately localises 15%–21% of lesions and is highly dependent on many variables including operator skill 2–6 . Tattoo marking has higher localisation rates but can only be seen intra‐operatively.…”