title: Discrepancy between gastroenterologists' and general surgeons' perspectives on repeat endoscopy in colorectal cancer.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos).
authors.forename: Arash
authors.initials: A
authors.lastname: Azin
authors.affiliation: From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos).
authors.forename: M Carolina
authors.initials: MC
authors.lastname: Jimenez
authors.affiliation: From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos).
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Cleghorn
authors.affiliation: From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos).
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
authors.affiliation: From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos).
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.affiliation: From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos).
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rossos
authors.affiliation: From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Azin); the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont. (Jimenez, Cleghorn, Jackson, Okrainec, Quereshy); the Department of Surgery, University of Toronto, Toronto, Ont. (Jackson, Okrainec, Quereshy); Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ont. (Rossos); and the Department of Medicine, University of Toronto, Toronto, Ont. (Rossos).
authors.forename: Fayez A
authors.initials: FA
authors.lastname: Quereshy
mesh_terms: D000328:Adult; D003113:Colonoscopy / Q000379:methods / Q000592:standards; D015179:Colorectal Neoplasms / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods* / Q000592:standards; D005260:Female; D005762:Gastroenterology / Q000379:methods* / Q000592:standards; D013502:General Surgery / Q000379:methods* / Q000592:standards; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data*; D066231:Surgeons / Q000706:statistics & numerical data
references.citation: World J Surg. 2010 Jul;34(7):1587-91
references.pmid: 20054542
references.citation: Ann Intern Med. 2008 Nov 4;149(9):659-69
references.pmid: 18838717
references.citation: Surg Endosc. 2014 Oct;28(10):2808-14
references.pmid: 24853842
references.citation: World J Gastrointest Surg. 2010 Jan 27;2(1):22-5
references.pmid: 21160830
references.citation: Colorectal Dis. 2011 Oct;13(10):1184-7
references.pmid: 20860715
references.citation: World J Surg. 2007 Jul;31(7):1491-5
references.pmid: 17534547
references.citation: Can J Gastroenterol Hepatol. 2014 Apr;28(4):185-90
references.pmid: 24729991
references.citation: Surg Endosc. 1997 Oct;11(10):1013-6
references.pmid: 9381339
references.citation: Surg Endosc. 2012 Nov;26(11):3264-6
references.pmid: 22609983
references.citation: Dis Colon Rectum. 2001 May;44(5):713-6
references.pmid: 11357034
references.citation: Surg Endosc. 1994 Sep;8(9):1085-7
references.pmid: 7992181
references.citation: Rev Med Chir Soc Med Nat Iasi. 2007 Jan-Mar;111(1):39-43
references.pmid: 17595844
references.citation: Arch Surg. 2005 Oct;140(10):932-5
references.pmid: 16230540
references.citation: Surg Endosc. 2001 Oct;15(10):1202-3
references.pmid: 11727100
references.citation: World J Gastroenterol. 2012 Jul 21;18(27):3551-7
references.pmid: 22826619
references.citation: Rev Esp Enferm Dig. 2012 Oct-Nov;104(10):512-7
references.pmid: 23268629
references.citation: Surg Endosc. 2010 Oct;24(10):2502-5
references.pmid: 20333403
references.citation: Surg Endosc. 2012 Nov;26(11):3101-5
references.pmid: 22692461
references.citation: Can J Gastroenterol. 2008 Jun;22(6):565-70
references.pmid: 18560635
references.citation: Surg Endosc. 2015 Sep;29(9):2569-75
references.pmid: 25480606