Post-Colonoscopy Colorectal Cancer Etiologies in a Large Integrated US Health Care Setting

Leung, Lawrence Jun; Lee, Jeffrey K.; Merchant, Sophie A.; Jensen, Christopher D.; Alam, Asim; Corley, Douglas A.

doi:10.1053/j.gastro.2022.11.031

Cited by 7 publications

(11 citation statements)

References 11 publications

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“…[5] Indeed, most PCCRCs originate from missed or incompletely resected lesions. [6,7] PCCRCs are often right-sided and hypermethylated, both features consistent with an origin from serrated polyps. [8,9] This is not surprising for at least three reasons.…”

Section: Introductionmentioning

confidence: 79%

Effect of an E-learning resource on endoscopists’ proximal serrated polyp detection rate: a randomized controlled trial

van Toledo,

IJspeert,

Bleijenberg

et al. 2024

Endoscopy

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Background Recent studies demonstrated that a higher proximal serrated polyp detection rate among endoscopists is associated with a lower risk of post-colonoscopy colorectal cancer (PCCRC) incidence and death for their patients. Our objective was to evaluate the effect of an e-learning on proximal serrated polyp detection rate (PSPDR). Methods We performed a multicentre randomised controlled trial within the Dutch fecal immunochemical test based colorectal cancer screening program. Endoscopists were randomized using block-randomization per centre to receive an e-learning of 60 minutes on serrated polyp detection or not. PSPDR was calculated based on all colonoscopies performed during 27 months pre-intervention and 17 months post-intervention. Primary endpoint was difference in PSPDR between intervention and control arm (intention to treat) using mixed effect logistic regression modelling with time (pre-intervention/post-intervention) and interaction between time and arm (intervention/control) as fixed effects and endoscopist as random effect. Results Fifty-seven endoscopists were included in the intervention arm and fifty-nine endoscopists were included as controls. They performed in total 27,494 and 33,888 colonoscopies, respectively. Median PSPDR pre-intervention was 13.6% (95% CI,13.0-14.1) for the intervention arm and 13.8% (13.3-14.3) for controls. Post-intervention, the PSPDR was significantly higher over time in the intervention arm than controls (17.1% vs 15.4%, p=0.01). Conclusion In an era of increased awareness and increasing PSPDRs, endoscopists who performed an one-time e-learning significantly accelerated the increase of PSPDR compared to endoscopists who did not receive the e-learning. Widespread implementation might reduce PCCRCs incidence. This trial was registered with the Netherlands Trial Register, number NL8385.

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Section: Introductionmentioning

confidence: 79%

Effect of an E-learning resource on endoscopists’ proximal serrated polyp detection rate: a randomized controlled trial

van Toledo,

IJspeert,

Bleijenberg

et al. 2024

Endoscopy

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“…Evidence from the literature supports that the cecal intubation rate is inversely correlated with PCCRC 37,38 . An administrative database of Ontario Health Insurance was used to examine the relationship between endoscopist factors and PCCRC risk 10 . Of 14,064 patients with CRC, 1260 patients (9%) were identified as having PCCRC, including 676 PCCRCs located in the proximal colon and 584 PCCRCs in the distal colon.…”

Section: Cecal Intubation Ratementioning

confidence: 99%

“…37,38 An administrative database of Ontario Health Insurance was used to examine the relationship between endoscopist factors and PCCRC risk. 10 Of 14,064 patients with CRC, 1260 patients (9%) were identified as having PCCRC, including 676 PCCRCs located in the proximal colon and 584 PCCRCs in the distal colon. Patients who underwent colonoscopy by an endoscopist with a high cecal intubation rate (≥95%) were less likely to have PCCRC than those who underwent colonoscopy by an endoscopist with a low cecal intubation rate (<80%) for proximal (OR 0.72, 95% CI 0.53-0.97) and distal PCCRC (OR 0.73, 95% CI 0.54-0.97).…”

Section: Cecal Intubation Ratementioning

confidence: 99%

“…A recent community‐based study from the United States 10 underlined that most PCCRCs are avoidable. The authors demonstrated the etiologies of 336 patients with PCCRCs according to the World Endoscopy Organization consensus on PCCRCs 11 .…”

Section: Introductionmentioning

confidence: 99%

“…The authors demonstrated the etiologies of 336 patients with PCCRCs according to the World Endoscopy Organization consensus on PCCRCs 11 . The plausible explanation for PCCRC was classified into: (i) possible missed lesion, adequate examination (70.2%); (ii) possible missed lesion, inadequate examination (15.5%); (iii) likely incomplete resection (11%); and (iv) detected lesion, not resected (3.3%) 10 . Missed and incomplete or unresected lesions should be targets for quality improvement.…”

Section: Introductionmentioning

confidence: 99%

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What are the priority quality indicators for colonoscopy in real‐world clinical practice?

Tiankanon

Aniwan

2023

Digestive Endoscopy

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Colonoscopy is widely used as a colorectal cancer (CRC) screening tool. The effectiveness of a screening colonoscopy is associated with a decreased risk of CRC. However, colonoscopy is an operator‐dependent procedure, and endoscopists' quality performance varies widely. This article reviewed the priority metrics and practices that contribute to high‐quality screening colonoscopy in real‐world clinical practice. With growing evidence, quality indicators have been subject to intense research and associated with reducing postcolonoscopy CRC incidence and mortality. Some quality metrics can reflect an endoscopy unit‐based practice (i.e. quality of bowel preparation and withdrawal time). Other quality indicators primarily reflect individuals' skill and knowledge (i.e. cecal intubation rate, adenoma detection rate, and appropriately assigned follow‐up colonoscopy interval). Measurement and improvement of priority quality indicators for colonoscopy should be made at both the endoscopist and unit levels. Substantial evidence supports the impact of high‐quality colonoscopy in reducing the incidence of postcolonoscopy CRC.

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Incidence, characteristics, and predictive factors of post‐colonoscopy colorectal cancer

Baile‐Maxía,

Mangas‐Sanjuan,

Sala‐Miquel

et al. 2024

UEG Journal

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BackgroundPost‐colonoscopy colorectal cancer (PCCRC) is colorectal cancer (CRC) diagnosed after a colonoscopy in which no cancer is found.ObjectiveAs PCCRC has become an important quality indicator, we determined its rates, characteristics, and index colonoscopy‐related predictive factors.MethodsWe carried out a multicenter, observational, retrospective study between 2015 and 2018. Rates were calculated for PCCRC developing up to 10 years after colonoscopy. PCCRC was categorized according to the most plausible explanation using World Endoscopy Organization methodology. Our PCCRC population was compared to a control cohort without CRC matched 1:4 by sex, age, index colonoscopy date, indication, endoscopist, and hospital.ResultsOne hundred seven PCCRC and 2508 detected CRC were diagnosed among 101,524 colonoscopy (0.1%), leading to rates of 0.4%, 2.2%, 3.1%, and 4.1% at 1, 3, 5, and 10 years, respectively. PCCRC was in right (42.4%), left (41.4%), and transverse (16.4%) colon with 31.5% at stage I, 24.7% stage II, 32.6% stage III, and 11.2% stage IV. Twenty point three percent were classified as incomplete resection, 5.4% as unresected lesions, 48.6% as missed lesions with adequate colonoscopy, and 25.7% as missed lesions with inadequate colonoscopy. The median time from colonoscopy to PCCRC was 42 months. Previous inadequate preparation (OR 3.05, 95%CI 1.73–5.36) and piecemeal polypectomy (OR 19.89, 95%CI 8.67–45.61) were independently associated with PCCRC.ConclusionsIn our population, 4.1% of CRC cases were PCCRC. Most of these lesions were in right colon and attributable to lesions not visualized despite adequate bowel cleansing. Previous inadequate cleansing and piecemeal polypectomy were associated with PCCRC.

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Post-Colonoscopy Colorectal Cancer Etiologies in a Large Integrated US Health Care Setting

Cited by 7 publications

References 11 publications

Effect of an E-learning resource on endoscopists’ proximal serrated polyp detection rate: a randomized controlled trial

Effect of an E-learning resource on endoscopists’ proximal serrated polyp detection rate: a randomized controlled trial

What are the priority quality indicators for colonoscopy in real‐world clinical practice?

Incidence, characteristics, and predictive factors of post‐colonoscopy colorectal cancer

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