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

• Published in: Canadian Journal of Surgery 2016-02, Vol.59 (1), p.29-34
• Main Authors: Azin, Arash, MD, Jimenez, M. Carolina, MD, MSc, Cleghorn, Michelle C., MSc, Jackson, Timothy D., MD, MPH, Okrainec, Allan, MD, MHPE, Quereshy, Fayez A., MD, MBA, Rossos, Peter G., MD, MBA
• Format: Article
• Language: English
• Subjects: Adult; Analysis; Colonoscopy - methods; Colonoscopy - standards; Colorectal cancer; Colorectal Neoplasms - surgery; Colorectal surgery; Comparative analysis; Diagnosis; Endoscopy; Endoscopy, Gastrointestinal - methods; Endoscopy, Gastrointestinal - standards; Female; Gastroenterologists; Gastroenterology; Gastroenterology - methods; Gastroenterology - standards; General Surgery - methods; General Surgery - standards; Health Care Surveys; Humans; Male; Methods; Middle Aged; Physicians - statistics & numerical data; Surgeons; Surgeons - statistics & numerical data; Surgery; Surgical techniques
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.005115

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.