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.
Highlights
Background Colonoscopy 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
A recent small prospective multi-centre audit in the West of Scotland reported incorrect lesion localisation at colonoscopy in 19% of cases that led to an on-table alteration in surgical management in 6% [2]
Analysis of patient and colonoscopic factors found that colonoscopy accreditation, use of the scope guide, caecal intubation and previous abdominal surgery all significantly influenced accurate lesion localisation
Summary
Patients undergoing colonoscopy prior to elective curative surgery for colorectal lesion/s were included from 8 registered U.K. sites (2012–2014). Previous publications have varied in the reported accuracy of colonoscopy with incorrect lesion localisation documented from 1.7 to 40.3% [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20] The majority of these studies are retrospective and single centre in design, making conclusions difficult. A recent small prospective multi-centre audit in the West of Scotland reported incorrect lesion localisation at colonoscopy in 19% of cases that led to an on-table alteration in surgical management in 6% [2]. This study aimed to perform a large multi-centre audit across the U.K. to first assess the accuracy of colonoscopic lesion localisation and any subsequent operative consequences and second to determine potential influencing factors
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