Endoscopic clips allow for accurate pre-operative localisation of colorectal cancer

Simon Parys, Hyerin Park, Fiona Entriken, Hooi C Ee, Rupert Hodder

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


BACKGROUND: Colorectal cancer is a major cause of morbidity and mortality worldwide. Optimal management of this disease relies upon accurate pre-operative localisation to allow multidisciplinary discussion and treatment planning. Current pre-operative localisation methods consist of colonoscopy and computed tomography (CT), which are only 79%-85% accurate. To minimise this error, colonoscopy tattooing is a routine practice to facilitate operative localisation. The aim of this study is to investigate if endoscopic radiopaque clips can more accurately localise the lesions pre-operatively.

METHODS: A retrospective case-control study was conducted of patients diagnosed with colorectal cancer at a tertiary hospital between 2017 and 2019. Visualisation rates and accurate localisation rates were compared between patients receiving radiopaque clips and those who had colonoscopy alone. All patients received a tattoo distal to the tumour and a staging CT. Data on patient demographics, tumour demographics, post-procedure complications and changes to surgical management were collected.

RESULTS: Of 285 patients, 245 had tumour localisation with colonoscopy alone and 40 had additional clip localisation. Groups had comparable patient demographics. For patients receiving clips and follow-up CTs within 14 days, 92% of lesions were visualised and 100% of these lesions were accurately localised. In contrast, colonoscopy only accurately localised 77% of lesions (p < 0.01). This resulted in 1.2% of patients requiring an altered operation due to incorrect localisation. No clip-related complications were reported.

CONCLUSION: Radiopaque clips are a highly accurate and cost-effective method for localising colorectal cancer with a pre-operative accuracy rate over 92%.

Original languageEnglish
Pages (from-to)2121-2125
Number of pages5
JournalANZ Journal of Surgery
Issue number10
Early online date28 Jun 2021
Publication statusPublished - Oct 2021
Externally publishedYes


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