Abstract
Background
Colonoscopy findings compared with findings at time of surgery have a discrepancy rate of 3–21%. The objective of our study was to investigate this discrepancy and provide potential resolutions.
Methods
In this retrospective study, we identified 400 patients who underwent colonoscopy followed by colon resection at our community hospitals in 1999–2006. Discrepancies between colonoscopy and intraoperative findings were noted. Each discrepancy was classified as major if the surgical procedure had to be altered, the lesion was missed, an unnecessary segment was removed, or the incision was extended. A discrepancy was classified as minor if there was no alteration in planned surgery.
Results
Of the 400 cases, 160 (40%) were located in the right colon, 13 (3%) were in the transverse colon, 185 (46%) were in the left colon, and 42 (11%) were in the rectum. A total of 48 (12%) discrepancies between colonoscopy and intraoperative findings were identified: 26 (54%) were major and 22 (46%) were minor. Thirteen (27%) were in the proximal colon (3 major and 10 minor discrepancies), 3 (6.3%) were in the transverse colon (all major), 22 (46%) were in the distal colon (17 major and 5 minor), and 10 (21%) were in the rectum (3 major, 7 minor). Major discrepancies were significantly higher in the left colon (17 of the 185 left-sided lesions; 9.1%) than in the right colon (3/160; 1.9%; P = 0.045).
Conclusions
In our study, colonoscopy has an error rate of 12% when used to localize tumors; more than half of these patients require significant unanticipated changes in their surgery. The discrepancies are significantly higher in left side of colon.
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References
Piscatelli N, Hyman N, Osler T (2005) Localizing colorectal cancer by colonoscopy. Arch Surg 140:932–935
Jemal A, Murray T, Samuels A et al (2003) Cancer statistics, 2003. CA Cancer J Clin 53:5–26
Gupta AK, Melton LJ 3rd, Petersen GM et al (2005) Changing trends in the incidence, stage, survival, and screen-detection of colorectal cancer: a population-based study. Clin Gastroenterol Hepatol 3:150–158
Atkin W (2003) Options for screening for colorectal cancer. Scand J Gastroenterol 237(Suppl):13–16
Santoro GA, D’Elia A, Battistella G et al (2007) The use of a dedicated rectosigmoidoscope for ultrasound staging of tumours of the upper and middle third of the rectum. Colorectal Dis 9:61–66
Mathew J, Shankar P, Aldean IM (2004) Audit on flexible sigmoidoscopy for rectal bleeding in a district general hospital: are we over-loading the resources? Postgrad Med J 80:38–40
Rockey DC, Paulson E, Niedzwiecki D et al (2005) Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Lancet 365:305–311
Wexner SD, Cohen SM, Ulrich A et al (1995) Laparoscopic colorectal surgery—are we being honest with our patients? Dis Colon Rectum 38:723–727
Hancock JH, Talbot RW (1995) Accuracy of colonoscopy in localisation of colorectal cancer. Int J Colorectal Dis 10:140–141
Eisenberg JM (2000) The best offense is a good defense against medical errors: putting the full-court press on medical errors. Agency for Healthcare Research and Quality, Rockville. January 20, 2000. http://www.ahrq.gov/news/spch012000.htm. Accessed 1 June 2007
Leaper M, Johnston MJ, Barclay M et al (2004) Reasons for failure to diagnose colorectal carcinoma at colonoscopy. Endoscopy 36:499–503
Rex DK (2006) Maximizing detection of adenomas and cancers during colonoscopy. Am J Gastroenterol 101:2866–2877
Karl RC (2007) Staying safe: simple tools for safe surgery. Bull Am Coll Surg 92:16–22
Feingold DL, Addona T, Forde KA et al (2004) Safety and reliability of tattooing colorectal neoplasms prior to laparoscopic resection. J Gastrointest Surg 8:543–546
Askin MP, Waye JD, Fiedler L et al (2002) Tattoo of colonic neoplasms in 113 patients with a new sterile carbon compound. Gastrointest Endosc 56:339–342
Kohn LT, Corrigan JM, Donaldson MS (eds) (2000) To err is human: building a safer health care system [monograph on the Internet]. National Academies Press, Washington. http://www.nap.edu/catalog/9728.html. Accessed 2007 June 1 2007
Acknowledgments
The authors thank Rosanne Russo for Tumor registry and Rita Raio for written project coordination.
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Louis, M.A., Nandipati, K., Astorga, R. et al. Correlation Between Preoperative Endoscopic and Intraoperative Findings in Localizing Colorectal Lesions. World J Surg 34, 1587–1591 (2010). https://doi.org/10.1007/s00268-009-0358-y
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DOI: https://doi.org/10.1007/s00268-009-0358-y