Predictors and rates of prior endoscopic tattoo localization amongst individuals undergoing elective colorectal resectio
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and Other Interventional Techniques
Predictors and rates of prior endoscopic tattoo localization amongst individuals undergoing elective colorectal resections for benign and malignant lesions Olivia Hershorn1 · Jason Park1 · Harminder Singh2 · Kathleen Clouston1 · Ashley Vergis1 · Ramzi M. Helewa1 Received: 8 July 2020 / Accepted: 25 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Appropriate tattooing of suspicious lesions during colonoscopy is critical for surgical planning. However, variability exists in tattoo placement, technique, and reporting. Our aim is to determine the rates and predictors of tattoo placement, tattoo location in relation to the lesion, and localization accuracy during lower endoscopy for individuals undergoing elective colorectal resections. Methods We performed a retrospective chart review on all patients undergoing elective colorectal resections for benign and malignant neoplasms between 2007 and 2017 at a high volume Canadian tertiary centre. Patient demographics, endoscopic, and tumour-related characteristics were collected. Multivariable logistic regression analysis was used to identify predictors of tattoo localization. Results Of the 1062 patients identified, laparoscopic resection occurred in 59% of patients. 57% of patients underwent tattooing for tumour localization at index endoscopy. Tattoos were placed distal (27%), both proximal and distal (4%), and just proximal (2%) to the lesion. However, in the majority of cases the tattoo location was not documented (67%). On multivariate analysis, patients who had lesions located in the transverse colon (OR: 1.93, 95% CI 1.04–3.59), had surgery performed after 2010 (2011–2014: OR: 1.88, 95% CI 1.31–2.68; 2015–2017: OR: 2.87, 95% CI 1.93–4.26), underwent laparoscopic resections (OR: 1.69, 95% CI 1.22–2.33), and had their index endoscopy performed in an urban setting (OR: 5.92, 95% CI 3.23–10.87), were at higher odds of having a tattoo placed at index endoscopy. Conclusion Endoscopic tattoo placement and location in relation to the lesion varies widely, with reports containing suboptimal documentation. Lesion location and laparoscopic procedures were significant predictors of tattoo placement. This study highlights the need for standardized tattooing practices and reporting amongst endoscopists. One of the focus of quality improvement efforts should be educational initiatives for rural endoscopists. Keywords Colorectal cancer · Colonoscopy · Endoscopy · Tattoo localization Endoscopic tattoo localization for colorectal lesions has become a crucial component of surgical planning to ensure accurate identification of lesions prior to surgical resection.
* Olivia Hershorn [email protected] * Ramzi M. Helewa [email protected] 1
Section of General Surgery, Department of Surgery, University of Manitoba, Tache Avenue, Z3049‑409, Winnipeg, MB R2H 2A6, Canada
Section of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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