Discrepancy between gastroenterologists’ and general surgeons’ perspectives on repeat endoscopy in colorectal cancer

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 χ 2 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. Contexte :De nombreuses options de repérage s'offrent aux endoscopistes dans les cas de cancer colorectal; on en sait cependant peu sur l'utilisation de ces techniques et leur lien avec les endoscopies répétées avant les interventions chirurgicales de traitement de ce cancer. Nous avons étudié les pratiques de repérage employées par des gastroentérologues et comparé leurs perceptions des endoscopies répétées à celles des chirurgiens généralistes.Méthodes : Nous avons réalisé un sondage auprès de gastroentérologues en exercice figurant dans un répertoire provincial. Une analyse unidimensionnelle a été effectuée à l'aide du test χ².

Inconsistencies in Colonic Tattooing Practice: Differences in Reported and Actual Practices at a Tertiary Medical Center

“…Having an initial colonoscopy undertaken by the same surgeon who performs the follow-up operation has been associated with improved intraoperative localization of colonic tattoos. 10 Because initial colonoscopy often is performed by a gastroenterologist with referral to a specialist, appropriate tattooing accompanied by a clear endoscopy report are likely to facilitate patient care. A published discussion of colonic tattooing implored endoscopists to provide details in the endoscopy report that specify the tattoo location relative to the lesion.…”

Sampling error in the diagnosis of colorectal cancer is associated with delay to surgery: a retrospective cohort study

“…This is therefore a rare occurrence at our institution. Endoscopist rationale for repeat endoscopy has been examined previously by ourselves and others [ 23 , 24 ]. One possible reason to repeat the endoscopy would be to try and avoid surgery altogether if a diagnosis of cancer was uncertain.…”

Preoperative repeat endoscopy for colorectal cancer: What is its role and when is it necessary?

“…This is reported as a common indication for preoperative repeat endoscopy given the variety of localization techniques used by endoscopists and the lack of standardization in endoscopic reports. 2 In fact, Al Abbasi and colleagues 1 found a decrease in the repeat endoscopy rate when the operating surgeon was consulted at the time of the initial endoscopy. The clinical reasoning behind tattooing and accurate localization of the lesion was well understood by patients, and they favoured the idea of having their surgeon perform a second endoscopy.…”

“…1 This practice has, in part, resulted from a shift in surgical management, with increasing reliance on minimally invasive techniques, but also from a lack of standardized guidelines on appropriate tumour localization, including tattooing, and optimal colonoscopic reporting among clinicians. 2,3 However, despite its increasing use and potential role in correcting localization errors, the procedure itself carries inherent risk, may lead to patient discomfort, and is associated with a delay to definitive treatment. 4 Given that the current evidence surrounding the utility of repeat endoscopy is limited, this raises important questions about its role in preoperative care and the need for evidencebased clinical guidelines that identify when a repeat endoscopy is necessary and when it is not.…”

“…2,3 However, as an intervention that may not be necessary in every case and that may increase the burden on patients receiving cancer care, it is important to also consider the patients' understanding and perceptions of repeat endoscopy. Thus, we surveyed patients in our colorectal practice to further explore the role of repeat endoscopy and improve the quality and experience of preoperative care.…”