Recommendations for Optimal Endoscopic Localization of Colorectal Neoplasms: A Consensus Delphi of National Experts

BACKGROUND: Colonoscopy is the standard of care for diagnosis and evaluation of colorectal cancers prior to surgery. However, varied practices and heterogenous documentation affects communication between endoscopists and operating surgeons, hampering surgical planning. OBJECTIVE: This study aimed to develop recommendations for the use of standardized localization and reporting practices for colorectal lesions identified at lower gastrointestinal endoscopy. DESIGN: A systematic review of existing endoscopy guidelines, and thorough narrative review of the overall endoscopy literature were performed to identify existing practices recommended globally. An online Delphi process was used to establish consensus recommendations based on literature review. SETTING: Colorectal surgeons and gastroenterologists from across Canada who had previously demonstrated leadership in endoscopy, managed large endoscopy programs, produced high impact publications in the field of endoscopy, or have participated in the development of endoscopy guidelines, were selected to participate. PRIMARY OUTCOME MEASURES: Colorectal lesion localization and documentation practice recommendations important to planning surgical or advanced endoscopic excisions. RESULTS: At total of 129 of 197 statements achieved consensus after three rounds of voting by 23 experts from across Canada. There was >90% participation in each round. Recommendations varied according to lesion location in the cecum, colon, or rectum, and whether referral was planned for surgical or advanced endoscopic resection. Recommendations were provided for appropriate documentation, indications, location and method of tattoo placement, in addition to photograph and real-time 3D scope configuration device use. LIMITATIONS: Due to a paucity of evidence, recommendations are based primarily on expert opinion. There may be bias, as representatives were based in Canada. CONCLUSIONS: Best practices to optimize endoscopic lesion localization and communication are not addressed in previous guidelines. This consensus involving national experts in colorectal surgery and gastroenterology provides a framework for efficient and effective colorectal lesion localization. See Video Abstract at https://links.lww.com/DCR/C71.