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Post colonoscopy cancer rate (PCCRC-3Y) at a tertiary referral hospital in Australia - A data linkage analysis.
Journal of Gastroenterology and Hepatology 2022 November 28
INTRODUCTION: Colorectal cancer (CRC) diagnosed following a cancer-negative colonoscopy is termed as post-colonoscopy CRC (PCCRC). The World Endoscopy Organization has recently standardized definition of PCCRC-3Y (CRC developing within 3 years of a cancer-negative colonoscopy). In the present study, we sought to assess PCCRC-3Y rate, perform root-cause analyses and identify factors associated with development of PCCRC at a tertiary referral hospital in Australia.
METHODS: All patients undergoing colonoscopy from 2011 to 2018 were matched to a population-based cancer register. PCCRC-3Y rate was assessed for years 2011-2015. All PCCRC cases, that developed within 6-48 months after a cancer-negative colonoscopy underwent root-cause analyses. Descriptive statistics were used to summarize data.
RESULTS: Amongst 17,828 patients undergoing colonoscopy, 367 CRC cases were diagnosed during the study period. This included 9 PCCRC cases, which developed at a median of 14 months (range 7-34) after cancer-negative colonoscopy. The PCCRC-3Y rate for year 2011-2015 was 2.16% (95%CI 0.91-5.15). All 9 PCCRC cases were moderately or poorly differentiated adenocarcinomas. 7/9 were early-stage CRC (stage 1-2). 6/9 probably represented missed lesions at index colonoscopy despite an apparently adequate examination. History of inflammatory bowel disease (IBD) (OR 21.9, 95%CI 4.6-103.7, p<0.001) and diverticulosis (OR 5.4, 95%CI 1.4 - 20.5, p = 0.01) were significantly associated with development of missed CRC.
CONCLUSIONS: In our tertiary referral colonoscopy cohort, PCCRC-3Y rate was 2.16% (95%CI 0.91-5.15). IBD and diverticulosis were significantly associated with risk of PCCRC. The majority of PCCRC lesions were likely missed at index colonoscopy, despite an apparently adequate examination.
METHODS: All patients undergoing colonoscopy from 2011 to 2018 were matched to a population-based cancer register. PCCRC-3Y rate was assessed for years 2011-2015. All PCCRC cases, that developed within 6-48 months after a cancer-negative colonoscopy underwent root-cause analyses. Descriptive statistics were used to summarize data.
RESULTS: Amongst 17,828 patients undergoing colonoscopy, 367 CRC cases were diagnosed during the study period. This included 9 PCCRC cases, which developed at a median of 14 months (range 7-34) after cancer-negative colonoscopy. The PCCRC-3Y rate for year 2011-2015 was 2.16% (95%CI 0.91-5.15). All 9 PCCRC cases were moderately or poorly differentiated adenocarcinomas. 7/9 were early-stage CRC (stage 1-2). 6/9 probably represented missed lesions at index colonoscopy despite an apparently adequate examination. History of inflammatory bowel disease (IBD) (OR 21.9, 95%CI 4.6-103.7, p<0.001) and diverticulosis (OR 5.4, 95%CI 1.4 - 20.5, p = 0.01) were significantly associated with development of missed CRC.
CONCLUSIONS: In our tertiary referral colonoscopy cohort, PCCRC-3Y rate was 2.16% (95%CI 0.91-5.15). IBD and diverticulosis were significantly associated with risk of PCCRC. The majority of PCCRC lesions were likely missed at index colonoscopy, despite an apparently adequate examination.
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