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

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Abstract

Background

Despite limited endoscopy resources, repeat endoscopy prior to surgery is commonly practised. Our aim was to determine repeat preoperative endoscopy rates and factors influencing this practice at a high-volume Canadian tertiary centre.

Method

A retrospective cohort study was conducted on all patients undergoing elective colorectal resections for benign and malignant neoplasms at a tertiary centre in Winnipeg, Canada between 2007 and 2017. Multivariable logistic regression analysis was used to identify predictors of repeat preoperative endoscopy.

Results

Of 1062 patients identified, mean age was 68 years and 56% were male. Rate of repeat preoperative endoscopy was 29%. On multivariable analysis, male sex (OR 1.68, CI 1.19–2.34, p = 0.003) and lesions located in the left colon (OR 2.73, CI 1.79–4.14, p < 0.001), rectosigmoid (OR 9.11, CI 2.14–38.8, p = 0.003), and rectum (OR 4.06, CI 2.58–6.38, p < 0.001) were at increased odds of undergoing repeat preoperative endoscopy. Patients with a tattoo placed at index endoscopy were at markedly lower odds of undergoing repeat preoperative endoscopy (OR 0.48, CI 0.34–0.68, p < 0.001). Index endoscopist specialty was not a significant predictor of repeat endoscopy (OR 0.76, CI 0.54–1.06, p = 0.09).

Conclusions

Repeat preoperative lower endoscopy is commonly practised and may be unnecessary if appropriate identification and documentation of lesions has been achieved. Tattooing of suspicious lesions is a key modifiable factor associated with reduced likelihood of repeat preoperative endoscopy. This study highlights the need for standardized guidelines and endoscopy reporting practices given the delays and costs associated with repeat preoperative endoscopy.

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Acknowledgements

The authors would like to thank Mr. Brenden Dufault for his contribution to the statistical analysis portion of the study and Ms. Ceceile Porter for her assistance with data collection.

Funding

The authors would like to acknowledge the financial support of the following granting agencies: The Manitoba Medical Services Foundation, The Canadian Society of Colon and Rectal Surgeons, and The Department of Surgery GFT Group Research Fund at the University of Manitoba.

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Authors and Affiliations

  1. Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada

    Olivia Hershorn, Jason Park, Kathleen Clouston, Ashley Vergis & Ramzi M. Helewa

  2. Section of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada

    Harminder Singh

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  1. Olivia Hershorn
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  2. Jason Park
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  3. Harminder Singh
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  4. Kathleen Clouston
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  5. Ashley Vergis
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  6. Ramzi M. Helewa
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Corresponding authors

Correspondence to Olivia Hershorn or Ramzi M. Helewa.

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Disclosures

Drs. Olivia Hershorn, Jason Park, Harminder Singh, Kathleen Clouston, Ashley Vergis, and Ramzi M. Helewa have no relevant conflicts of interest or financial ties to disclose.

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Hershorn, O., Park, J., Singh, H. et al. Rates and predictors of repeat preoperative endoscopy for elective colorectal resections: how can we avoid repeated procedures?. Surg Endosc 36, 4115–4123 (2022). https://doi.org/10.1007/s00464-021-08733-2

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  • DOI: https://doi.org/10.1007/s00464-021-08733-2

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