World Endoscopy Organization Consensus Statements on Post-Colonoscopy and Post-Imaging Colorectal Cancer

Rutter, Matthew D.; Beintaris, Iosif; Valori, Roland; Chiu, Han–Mo; Corley, Douglas A.; Cuatrecasas, Míriam; Dekker, Evelien; Forsberg, Anna; Gore-Booth, Jola; Haug, Ulrike; Kaminski, Michal F.; Matsuda, Takahisa; Meijer, Gerrit A.; Morris, Eva; Plumb, Andrew; Rabeneck, Linda; Robertson, Douglas J.; Schoen, Robert E.; Singh, Harminder; Tinmouth, Jill; Young, Graeme P.; Sanduleanu, Silvia

doi:10.1053/j.gastro.2018.05.038

Cited by 264 publications

(315 citation statements)

References 72 publications

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“…Although the term “interval CRC” was loosely adopted by previous studies, majority of these studies failed to meet the definition as proposed: “CRC diagnosed after a screening or surveillance exam in which no cancer is detected, and before the date of next recommended exam.” In particular, “interval cancer” applies to screening and surveillance programs only and hence is not optimal for routine colonoscopy quality assurance purposes . In this study, we followed the recent World Endoscopy Organization (WEO) consensus on advocating the PCCRC rate for an interval of 3 years (PCCRC‐3y) for benchmarking purposes.…”

Section: Methodsmentioning

confidence: 99%

“…Chi‐squared test or Fisher's exact test was applied for categorical variables. The PCCRC‐3y rate was calculated as per WEO consensus: False negatives/(True positives + False negatives), where false negatives refer to colonoscopy with CRC subsequently diagnosed between 6 and 36 months after the procedure and true positives refer to colonoscopy with CRC diagnosed at or within 6 months of the procedure . Count data and temporal trends were assessed by Poisson regression model.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, the PCCRC rate has been proposed to be the principal performance measure to monitor quality of a colonoscopy service to detect and prevent CRC . However, population‐based studies from Asia are sparse.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology, characteristics, and survival of post‐colonoscopy colorectal cancer in Asia: A population‐based study

Cheung

Chen

Seto

et al. 2019

J of Gastro and Hepatol

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Background and Aim Population‐based studies on post‐colonoscopy colorectal cancer (CRC) from Asia are sparse. We aimed to determine the characteristics and predictive factors and survival of post‐colonoscopy CRC in Hong Kong. Methods This is a territory‐wide retrospective cohort study. Patients aged ≥ 40 years with colonoscopies performed between 2005 and 2013 without history of CRCs, inflammatory bowel disease, and prior colectomy were included. Post‐colonoscopy colorectal cancer for an interval of 3 years (PCCRC‐3y) was defined as CRC diagnosed between 6 and 36 months after index colonoscopy, whereas CRC diagnosed within 6 months of index colonoscopy was regarded as “detected CRC.” We used multivariable logistic regression to derive adjusted odds ratio (aOR) of PCCRC‐3y and Cox model for adjusted hazard ratio (aHR) of cancer‐specific mortality after CRC diagnosis. Results Of the 197 902 eligible patients, 10 005 (92.1%) were detected CRC and 854 (7.9%) PCCRC‐3y. The median age at PCCRC‐3y diagnosis was 75.9 years (interquartile range: 65.5–83.8)—a delay of 1.2 years (interquartile range: 0.8–1.9) from index colonoscopy—and 60.1% were male. Predictive factors for PCCRC‐3y included older age (aOR: 1.07), male sex (aOR: 1.45), history of colonic polyps (aOR: 1.31), polypectomy/biopsy at index colonoscopy (aOR: 3.97), surgical endoscopists (aOR: 1.53), and a higher center annual endoscopy volume. Independent predictive factors for cancer‐specific mortality after CRC diagnosis included PCCRC‐3y (aHR: 1.32), proximal cancer location (aHR: 1.80), and certain patient factors. Conclusion The PCCRC‐3y rate was 7.9% in Hong Kong, with a high proportion (> 80%) of distal cancers and a higher cancer‐specific mortality compared with detected CRC.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Epidemiology, characteristics, and survival of post‐colonoscopy colorectal cancer in Asia: A population‐based study

Cheung

Chen

Seto

et al. 2019

J of Gastro and Hepatol

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“…They found that if polypectomy was performed only during withdrawal, a significant number of polyps could be missed. Missing colon adenomas was associated with the development of post‐colonoscopy CRC . Thus, it is rational to resect small polyps when they are encountered during colonoscope insertion, and this could reduce the chance of being unable to locate the polyp on withdrawal.…”

Section: Discussionmentioning

confidence: 99%

Comparison of polyp detection during both insertion and withdrawal versus only withdrawal of colonoscopy: A prospective randomized trial

Cheng

Kuo

Liu

et al. 2019

J of Gastro and Hepatol

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Background and Aims Polyps seen and not removed during colonoscope insertion are sometimes unable to be found during withdrawal. We aimed to evaluate whether additional inspection and polypectomy during insertion increases adenoma detection rate (ADR) compared with inspection and polypectomy entirely during withdrawal. Methods A total of 421 patients aged ≥ 45 years and undergoing colonoscopy were prospectively randomized to receive inspection and polypectomy during both insertion and withdrawal (study group) or inspection and polypectomy entirely during withdrawal (control group). The primary outcome was the ADR. Secondary outcomes included other adenoma‐related parameters and procedure‐related measures. Results Baseline demographics, procedure indications, preparation quality, total procedure time, sedative doses, colonoscopy difficulty, and patient discomfort were similar between the groups. The insertion time was significantly longer in the study group (11.1 ± 4.8 vs 6.2 ± 4.7 min, P < 0.0001). The withdrawal time was significantly longer in the control group (29.2 ± 9.8 vs 23.1 ± 7.9 min, P < 0.0001). There was no significant difference in the ADR (63.5% [study group] vs 68.1% [control group]), the mean adenoma per procedure (1.6 ± 2.0 vs 1.9 ± 2.4), or the mean adenoma per positive procedure (2.5 ± 2.0 vs 2.7 ± 2.5) between groups. The proximal colon ADR was significantly higher in the control group compared with the study group (56.2% vs 46.0%, P = 0.041). Conclusions Additional inspection and polypectomy during colonoscope insertion did not improve ADR compared with inspection and polypectomy entirely during withdrawal. These results do not support an additional role for routine inspection during insertion (clinical trial registration number: NCT03444090).

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“…Unit-level data are now available which provide PCCRC rates. PCCRC is potentially a single benchmark standard for units to assess the colonoscopy service they provide 29. Despite this being a JAG standard (units should record PCCRC as adverse events and have a mechanism to capture these data), at present it is unclear how most units manage this.…”

Section: Introductionmentioning

confidence: 99%

British society of gastroenterology Endoscopy Quality Improvement Programme (EQIP): overview and progress

Rees¹,

Koo²,

Anderson

et al. 2019

Frontline Gastroenterol

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High quality gastrointestinal (GI) endoscopy improves patient care. Raising standards in endoscopy improves diagnostic accuracy, management of pathology and ultimately improves outcomes. Historical identification of significant variation in colonoscopy quality led to the development of the Joint Advisory Group (JAG) on GI Endoscopy, the Global Rating Scale (GRS), JAG Endoscopy Training System (JETS) training and certification. These measures led to major improvements in UK endoscopy but significant variation in practice still exists. To improve quality further the British Society of Gastroenterology Endoscopy Quality Improvement (EQIP) has been established with the aim of raising quality and reducing variation in the quality of UK endoscopy. A multifaceted approach to quality improvement (QI) will be undertaken and is described in this manuscript. Upper GI EQIP will support adoption of standards alongside regional upskilling courses. Lower GI EQIP will focus on supporting endoscopists to achieve current standards alongside approaches to reducing postcolonoscopy colorectal cancer rates. Endoscopic retrograde cholangiopancreatography EQIP will adopt a regional approach of using local data to support network-based QI. Newer areas of endoscopy practice such as small bowel endoscopy and endoscopic ultrasound will focus on identifying key performance indicators as well as standardising training and accreditation pathways. EQIP will also support QI in management of GI bleeding as well as standardising the approach to new techniques and technologies. Where evidence is lacking, approaches to gather new evidence and support the translation into clinical practice will be supported.

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World Endoscopy Organization Consensus Statements on Post-Colonoscopy and Post-Imaging Colorectal Cancer

Abstract: A 20-member international team has provided standardized methods for analysis of etiologies of PCCRCs and PICRCs and defines its use as a quality indicator. The team provides recommendations for clinicians, organizations, researchers, policy makers, and patients.

Cited by 264 publications

References 72 publications

Epidemiology, characteristics, and survival of post‐colonoscopy colorectal cancer in Asia: A population‐based study

Epidemiology, characteristics, and survival of post‐colonoscopy colorectal cancer in Asia: A population‐based study

Comparison of polyp detection during both insertion and withdrawal versus only withdrawal of colonoscopy: A prospective randomized trial

British society of gastroenterology Endoscopy Quality Improvement Programme (EQIP): overview and progress

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