Analysis of lesion localisation at colonoscopy: outcomes from a multi-centre U.K. study.
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.



Patients 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.



364 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).



Lesion 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.
Department of Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, Scotland, UK. susanmoug@nhs.net.
Susan J
SJ
Moug
Department of Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, Scotland, UK.
Spyridon
S
Fountas
Undergraduate Medical School, University of Glasgow, Glasgow, UK.
Mark S
MS
Johnstone
Undergraduate Medical School, University of Glasgow, Glasgow, UK.
Adam S
AS
Bryce
Department of Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, Scotland, UK.
Andrew
A
Renwick
Department of Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, Scotland, UK.
Lindsey J
LJ
Chisholm
Department of Surgery, North Bristol NHS Trust, Bristol, UK.
Kathryn
K
McCarthy
Department of Surgery, North Bristol NHS Trust, Bristol, UK.
Amy
A
Hung
Department of Surgery, University Hospital Crosshouse, Kilmarnock, UK.
Robert H
RH
Diament
Department of Surgery, University Hospital Crosshouse, Kilmarnock, UK.
John R
JR
McGregor
Department of Surgery, University Hospital Crosshouse, Kilmarnock, UK.
Myo
M
Khine
Department of Surgery, Hairmyres Hospital, Lanarkshire, UK.
James D
JD
Saldanha
Department of Surgery, Hairmyres Hospital, Lanarkshire, UK.
Khurram
K
Khan
Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK.
Graham
G
Mackay
Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK.
E Fiona
EF
Leitch
Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK.
Ruth F
RF
McKee
Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK.
John H
JH
Anderson
Department of Surgery, Royal Victoria Infirmary and Freeman Hospitals, Newcastle, UK.
Ben
B
Griffiths
Department of Surgery, Royal Victoria Infirmary and Freeman Hospitals, Newcastle, UK.
Alan
A
Horgan
Department of Surgery, Royal Victoria Infirmary and Freeman Hospitals, Newcastle, UK.
Sonia
S
Lockwood
Department of Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, Scotland, UK.
Carly
C
Bisset
Queen Elizabeth University Hospital, Glasgow, UK.
Richard
R
Molloy
Department of Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, Scotland, UK.
Mark
M
Vella
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D013222:State Medicine; D006113:United Kingdom / Q000453:epidemiology
Colonoscopy; Lesion localisation; Multi-centred audit