Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis

Abstract

Causes of Post-colonoscopy Colorectal Cancers Based on WorldEndoscopy Organization System of Analysis BACKGROUND & AIMS: Postcolonoscopy colorectal cancer (PCCRC) is CRC diagnosed after a colonoscopy in which no cancer was found. A consensus article from the World Endoscopy Organization (WEO) proposed an approach for investigating and categorizing PCCRCs detected within 4 years of a colonoscopy. We aimed to identify cases of PCCRC and the factors that cause them, test the WEO system of categorization, quantify the proportion of avoidable PCCRCs, and propose a target rate for PCCRCs detected within 3 years of a colonoscopy that did not detect CRC. METHODS: We performed a retrospective analysis of 107 PCCRCs identified at a single medical center in England from January 1, 2010, through December 31, 2017 using coding and endoscopy data. For each case, we reviewed clinical, pathology, radiology, and endoscopy findings. Using the WEO recommendations, we performed a root-cause analysis of each case, categorizing lesions as follows: possible missed lesion, prior examination adequate; possible missed lesion, prior examination inadequate; detected lesion, not resected; or likely incomplete resection of previously identified lesion. We determined whether PCCRCs could be attributed to the colonoscopist for technical or decision-making reasons, and whether the PCCRC was avoidable or unavoidable, based on the WEO categorization and size of tumor. The endoscopy reporting system provided performance data for individual endoscopists. RESULTS: Of the PCCRCs identified, 43% were in high-risk patients (those with

AGA Clinical Practice Update on Reducing Rates of Post-Endoscopy Esophageal Adenocarcinoma: Commentary

“…A recent analysis suggested that 89% of all PCCRCs may be avoidable, attributable to technical endoscopic factors, compromised decision-making, and administrative factors. 17 An adenoma detection rate (ADR) of 20% for individuals undergoing average-risk screening colonoscopy is a well-established quality indicator in CRC screening, first established in 2002 by the US Multi-Society Task Force on Colorectal Cancer. It is also known that ADR is inversely proportional to risk of developing PCCRC.…”

An “expressionistic” look at serrated precancerous colorectal lesions

“…The miss rate dropped to~10% for all lesions measuring ≥10 mm, but it remained high (~25%) for the lesions that were sessile or flat, the subset that includes SSLs. Most CRCs detected within 3 years of a negative colonoscopy derive from missed or incompletely-excised lesions, and these "interval" or "post-colonoscopy" malignancies are characterized by an over-representation of proximal-colon locations and cancers that develop along the serrated tumorigenic pathway [16][17][18][19].…”

An “Expressionistic” Look at Serrated Precancerous Colorectal Lesions

“…The miss rate dropped to ~ 10% for all lesions measuring ≥10 mm, but it remained high (~ 25%) for the lesions that were sessile or at, the subset that includes SSA/Ps. Most CRCs detected within 3 years of a negative colonoscopy derive from missed or incompletely-excised lesions, and these "interval" or "post-colonoscopy" malignancies are characterized by an overrepresentation of proximal-colon locations and cancers that develop along the serrated tumorigenic pathway [23] [24][25] [26].…”