National post-colonoscopy colorectal cancer data challenge services to improve quality of colonoscopy

Burr, Nicholas; Valori, Roland

doi:10.1055/a-0809-5233

Cited by 5 publications

(2 citation statements)

References 10 publications

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“…Previous national studies have also shown a higher PCCRC-3yr rate in IBD patients 2 7. In England, Burr et al found the PCCRC-3yr in people with IBD was more than three times greater than the entire study cohort 8. In Denmark, the relative risk of ulcerative colitis and Crohn’s disease has been shown to be 3.44 and 1.44, respectively,9 with a more recent study showing a PCCRC-3yr rate of 24.3% in IBD patients and 7.5% in non-IBD patients 7.…”

Section: Discussionmentioning

confidence: 93%

Validation of post-colonoscopy colorectal cancer (PCCRC) cases reported at national level following local root cause analysis: REFLECT study

Ahmad

Dhillon

Saunders

et al. 2022

Frontline Gastroenterol

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ObjectiveOur aim was to determine aetiology of post-colonoscopy colorectal cancers (PCCRCs) identified from population-based data through local root cause analysis at a high-volume mixed secondary and tertiary referral centre.Design/methodA subset of national cancer registration data, collected by the National Cancer Registration and Analysis Service, was used to determine PCCRCs diagnosed between 2005 and 2013 at our centre.Root cause analysis was performed for each identified PCCRC, using World Endoscopy Organisation recommendations, to validate it and assess most plausible explanation. We also assessed whether patient, clinician and/or service factors were primarily responsible.ResultsOf 107 ‘PCCRC’ cases provided from the national dataset, 20 were excluded (16 missing data, 4 duplicates). 87 ‘PCCRC’ cases were included of which 58 were true PCCRCs and 29 false PCCRCs.False PCCRCs comprised 17 detected cancers (cancer diagnosed within 6 months of negative colonoscopy) and 12 cases did not meet PCCRC criteria. Inflammatory bowel disease was the most common risk factor (18/58) and the most common site was rectum (19/58). The most common explanation was ‘possible missed lesion, prior examination negative but inadequate’ (23/58) and clinician factors were primarily responsible for PCCRC occurrence in most cases (37/58).ConclusionOur single-centre study shows, after local analysis, there was misclassification of PCCRCs identified from a population-based registry. The degree of such error will vary between registries. Most PCCRCs occurred in cases of sub-optimal examination as indicated by poor photodocumentation. Effective mechanisms to feedback root cause analyses are critical for quality improvement.

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Section: Discussionmentioning

confidence: 93%

Validation of post-colonoscopy colorectal cancer (PCCRC) cases reported at national level following local root cause analysis: REFLECT study

Ahmad

Dhillon

Saunders

et al. 2022

Frontline Gastroenterol

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“…Immortal time bias and lead-time bias were accounted for by ignoring deaths within 3 and 4 years of the index colonoscopy 5,19 : 1-year survival at 3 and 4 years from index colonoscopy was 76 (80%) of 95 and 59 (69.4%) of 85, respectively.…”

Section: Cancer Detailsmentioning

confidence: 99%

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

2020

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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

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Key quality indicators in colonoscopy

Rex

2022

Gastroenterology Report

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Many quality indicators have been proposed for colonoscopy, but most colonoscopists and endoscopy groups focus on measuring the adenoma detection rate and the cecal intubation rate. Use of proper screening and surveillance intervals is another accepted key indicator but it is seldom evaluated in clinical practice. Bowel preparation efficacy and polyp resection skills are areas that are emerging as potential key or priority indicators. This review summarizes and provides an update on key performance indicators for colonoscopy quality.

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National post-colonoscopy colorectal cancer data challenge services to improve quality of colonoscopy

Cited by 5 publications

References 10 publications

Validation of post-colonoscopy colorectal cancer (PCCRC) cases reported at national level following local root cause analysis: REFLECT study

Validation of post-colonoscopy colorectal cancer (PCCRC) cases reported at national level following local root cause analysis: REFLECT study

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

Key quality indicators in colonoscopy

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