Rates and predictors of repeat preoperative endoscopy for elective colorectal resections: how can we avoid repeated procedures?

Hershorn, Olivia; Park, Jason; Singh, Harminder; Clouston, Kathleen; Vergis, Ashley; Helewa, Ramzi M.

doi:10.1007/s00464-021-08733-2

Cited by 8 publications

(12 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Endoscopic tattooing has become the standard of care as a marker to assist in intra‐operative identification of colonic lesions and prospective follow‐up of colonic polyps 21,22 . Studies have also shown that identifying a colonic lesion location based on tattoo can be difficult in up to 30% of cases due to variations, inconsistency or suboptimal tattoo application 22–24 . Tattoing techniques vary, and colonoscopy reporting remains inconsistent 14,15,25 .…”

Section: Discussionmentioning

confidence: 99%

“…15,23,25,27 Colonoscopy reporting should clarify size of the lesion, distance from anal verge if relevant, tattoo location and technique, in order to prevent unnecessary repeat procedures, and to minimize delays in curative resection. 24 Rigid proctoscopic examination could also be added for accurate distance localisation from the anal verge because measurements with a flexible endoscope may be inaccurate. 28,29 We hope that this study has increased awareness of the need for tattooing and comprehensive documentation in order for accurate localisation of colorectal lesions.…”

Section: Discussionmentioning

confidence: 99%

“…21,22 Studies have also shown that identifying a colonic lesion location based on tattoo can be difficult in up to 30% of cases due to variations, inconsistency or suboptimal tattoo application. [22][23][24] Tattoing techniques vary, and colonoscopy reporting remains inconsistent. 14,15,25 Although our study reports surgeons having a higher tattoo rate (p = 0.126), there was no difference in the rate of repeat colonoscopy (p = 0.462).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A single centre audit: repeat pre‐operative colonoscopy

Chen

Nair

Saboo

et al. 2022

ANZ Journal of Surgery

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A single centre audit: repeat pre‐operative colonoscopy

Chen

Nair

Saboo

et al. 2022

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…2,4,5 With prior quantitative studies identifying repeat endoscopy rates between 29% and 40.5%, it is pertinent to determine why these procedures are being performed and how to minimize unnecessary repeat endoscopies. 3,6 Little is known with respect to perceptions, thought patterns, and shared decision-making made by gastroenterologists and surgeons who perform these procedures. Depending on the regional practice patterns, gastroenterologists may perform the majority of initial endoscopies before referring the patient to a surgeon.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Variability in Communication and Reporting Practices Between Gastroenterologists and General Surgeons Contributes to Repeat Preoperative Endoscopy for Colorectal Neoplasms: A Qualitative Analysis

Hershorn

Park

Singh

et al. 2021

Diseases of the Colon &Amp; Rectum

Self Cite

View full text Add to dashboard Cite

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 PRÁCTICAS DE COMUNICACIÓN Y PRESENTACIÓN DE INFORMES ENTRE GASTROENTERÓLOGOS Y CIRUJANOS GENERALES CONTRIBUYE A REPETIR LA ENDOSCOPIA PREOPERATORIA PARA LAS NEOPLASIAS COLORRECTALES: UN ANÁLISIS 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 espec...

show abstract