Accuracy of preoperative tumor localization in large bowel using 3D magnetic endoscopic imaging: randomized clinical trial

Miroslaw Szura, Artur Pasternak, Rafal Solecki, Maciej Matyja, Antoni Szczepanik, Andrzej Matyja, Miroslaw Szura, Artur Pasternak, Rafal Solecki, Maciej Matyja, Antoni Szczepanik, Andrzej Matyja

Abstract

Background: Laparoscopic surgery has become the standard treatment for colorectal cancer. A tumor that does not involve serosa is invisible intraoperatively, and manual palpation of the tumor during laparoscopy is not possible. Therefore, accurate localization of the neoplastic infiltrate remains one of the most important tasks prior to elective laparoscopic surgery. The aim of this study was to evaluate the utility of a magnetic endoscopic imaging (MEI) for precise preoperative endoscopic localization of neoplastic infiltrate within the large bowel.

Materials and methods: The study enrolled 246 patients who underwent elective surgery for colorectal cancer in 2012-2015 with accurate preoperative colonoscopic localization of the tumor. The analysis concerned patients with neoplastic infiltrate localized more than 30 cm from the anal verge. For evaluative purposes and accuracy of localization, the intestine was divided anatomically into 13 parts. Colonoscopic examinations were conducted with two types of endoscopes: group I-with MEI and group II-without MEI. Patients were assigned to the groups by random allocation. Ultimate confirmation of the tumor localization was accomplished by intraoperative evaluation.

Results: Group I involved 127 patients and group II 129. The two groups were compared in terms of age, sex, BMI and frequency of previous abdominal procedures. Proper localization of the lesion was confirmed in 95.23 % of group I patients and in 83.19 % of group II patients (p < 0.05). The greatest discrepancy in localization occurred in 8.9 % of patients from group I and 20 % of patients from group II in which the lesion was assessed primarily in the distal sigmoid.

Conclusions: A magnetic endoscopic imaging allows more accurate localization of neoplastic infiltrate within the large intestine compared to standard colonoscopy alone, especially within the sigmoid colon. This method can be particularly useful in planning and performing laparoscopic procedures to diminish the likelihood of improper bowel segment resection. CLINICALTRIALS.

Gov number: NCT01688557.

Keywords: Colonoscopy; Colorectal cancer; Magnetic positioning system; Scope Guide.

Conflict of interest statement

Miroslaw Szura, Artur Pasternak, Rafal Solecki, Maciej Matyja, Antoni Szczepanik and Andrzej Matyja have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Position detecting unit integrated in the EVIS EXERA III system
Fig. 2
Fig. 2
Electromagnetic receiver. The new Scope Guide receiver dish is compact and thin
Fig. 3
Fig. 3
CONSORT diagram of patient enrollment
Fig. 4
Fig. 4
Sections of the colon for the exact localization of cancer site

References

    1. Wehrmann K, Frühmorgen P. Evaluation of a new three-dimensional magnetic imaging system for use during colonoscopy. Endoscopy. 2002;34(11):905–908. doi: 10.1055/s-2002-35302.
    1. Leung JW, Thai A, Yen A, Ward G, Abramyan O, Lee J, Smith B, Leung F. Magnetic endoscope imaging (Scope Guide) elucidates the mechanism of action of the pain-alleviating impact of water exchange colonoscopy—attenuation of loop formation. J Interv Gastroenterol. 2012;2(3):142–146. doi: 10.4161/jig.23738.
    1. Ambardar S, Amell TD, Whelan RL, Nihalani A, Forde KA. A preliminary prospective study of the usefulness of a magnetic endoscope locating device during colonoscopy. Surg Endosc. 2005;19:897–901. doi: 10.1007/s00464-004-8948-0.
    1. Ellis KK, Fennerty MB. Marking and identifying colon lesions. Tattoos, clips and radiology in imaging the colon. Gastrointest Endosc Cin N Am. 1997;7:401–411.
    1. Ohdaira T, Konishi F, Nagai H, Kashiwagi H, Shito K, Togashi K, et al. Intraoperative localization of colorectal tumors in the early stages using a marking clip detector system. Dis Colon Rectum. 1999;42:1353–1355. doi: 10.1007/BF02234230.
    1. Conaghan PJ, Maxwell-Armstrong CA, Garrioch MV, Hong L, Acheson AG. Leaving a mark: the frequency and accuracy of tattoing prior to laparoscopic colorectal surgery. Colorectal Dis. 2011;13:1184–1187. doi: 10.1111/j.1463-1318.2010.02423.x.
    1. Yeung JM, Maxwell-Armstrong CA, Acheson AG. Colonic tattoing in laparoscopic surgery. Making the mark? Colorectal Dis. 2009;11:527–530. doi: 10.1111/j.1463-1318.2008.01706.x.
    1. Askin MP, Waye JD, Fiedler L, Harpaz N. Tattoo of colonic neoplasms in 113 patients with a new sterile carbon compound. Gastrointest Endosc. 2002;56:339–342. doi: 10.1016/S0016-5107(02)70035-7.
    1. Cho YB, Lee WY, Yun HR, Lee WS, Yun SH, Chun HK. Tumor localization for laparoscopic colorectal surgery. World J Surg. 2007;31:1491–1495. doi: 10.1007/s00268-007-9082-7.
    1. Ambardar S, Amell TD, Whelan RL, Nihalani A, Forde KA. A preliminary prospective study of the usefulness of a magnetic endoscope locating device during colonoscopy. Surg Endosc. 2005;19:897–901. doi: 10.1007/s00464-004-8948-0.
    1. Jees P, Bulut O, Almasi A, Waaddegaard P. The usefulness of a magnetic endoscope locating device in colonoscopy in daily practice: a prospective case-controlled study. Surg Endosc. 2009;23:1353–1355. doi: 10.1007/s00464-008-0179-3.
    1. Ellul P, Fogden E, Simpson C, Buhagiar A, McKaig B, Swarbrick E, et al. Colonic tumour localization using an endoscope positioning device. Correlation between preoperative endoscopic and intraoperative findings in localizing colorectal lesions. Eur J Gastroenterol Hepatol. 2011;23:488–491. doi: 10.1097/MEG.0b013e328346974b.
    1. Klare P, Hartrampf B, Haller B, Schlag C, Geisler F, Abdelhafez M, Einwächter H, Bajbouj M, Schmid RM, von Delius S. Magnetic endoscope imaging for routine colonoscopy: impact on propofol dosage and patient safety–a randomized trial. Endoscopy. 2016 Jul 21. [Epub ahead of print] PubMed PMID: 27441684
    1. Kim JH, Kim WH, Kim TL, Kim NK, Lee KY, Kim MJ, et al. Incomplete colonoscopy in patients with occlusive colorectal cancer: usefulness of CT colonography according to tumor location. Yonsei Med J. 2007;48:934–941. doi: 10.3349/ymj.2007.48.6.934.
    1. Piscatelli N, Hyman N, Osler T. Localizing colorectal cancer by colonoscopy. Arch Surg. 2005;140:932–935. doi: 10.1001/archsurg.140.10.932.
    1. Lee J, Voytovich A, Pennoyer W, Thurston K, Kozol RA. Accuracy of colon tumor localization: computed tomography scanning as a complement to colonoscopy. World J Gastrointest Surg. 2010;2:22–25. doi: 10.4240/wjgs.v2.i1.22.
    1. Frager DH, Frager JD, Wolf EL, Beneventano TC. Problems in the colonoscopic localization of tumors: continued value of the barium enema. Gastrointest Radiol. 1987;12:343–346. doi: 10.1007/BF01885178.
    1. Wexner SD, Cohen SM, Ulrich A, Reissman P. Laparoscopic colorectal surgery: are we being honest with our patients? Dis Colon Rectum. 1995;38:723–727. doi: 10.1007/BF02048029.
    1. Vignati P, Welch JP, Cohen JL. Endoscopic localization of colon cancers. Surg Endosc. 1994;8:1085–1087. doi: 10.1007/BF00705725.
    1. Cho YB, Lee WY, Yun HR, Lee WS, Yun SH, Chun HK. Tumor localization for laparoscopic colorectal surgery. World J Surg. 2007;31(7):1491–1495. doi: 10.1007/s00268-007-9082-7.
    1. Fletcher RH. The end of barium enemas? N Engl J Med. 2000;342:1823–1824. doi: 10.1056/NEJM200006153422409.

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