P350 How many CRCs are being missed and why? An audit of PCCRCs at a DGH

Abstract

Introduction Post colonoscopy colorectal cancers (PCCRCs) are defined as a diagnosis of colorectal cancer (CRC) within 3 years of previously negative colonoscopy. The rate is usually calculated after 6 months and 3 years (PCCRC-3y) post- index colonoscopy. JAG states that PCCRCs should be viewed as an adverse event. We aim to evaluate the rate of PCCRCs in our centre. The primary endpoint was to review contributory factors to PCCRCs. The secondary endpoint was analysis of the total number of PCCRCs. Methods We retrospectively reviewed endoscopy reports for all patients diagnosed with CRC using Infoflex (reporting system) in the period Jan to Dec 2019. Results 3957 colonoscopies were performed Jan to Dec 2019. 134 (3.38%) patients were diagnosed with CRC. 3/134 (2.23%) patients had PCCRC-3y. All 3 patients were male (mean age 74) and an American Society of Anaesthesiologists (ASA) grade II. All 3 colonoscopies were performed by consultants during normal office hours. Bowel preparation (BP) was inadequate in 1/3. Withdrawal time (WT) and pain score were not recorded in any of the 3 cases. The lesions were found in the sigmoid colon (1), hepatic flexure (1) and caecum.1 Of the total cohort of 134 patients with CRC, 60.4% were males (mean age 68.4) and 39.5% were females (mean age 67.9). 58.2% had ASA II, 27.61% ASA I and 14.17% had ASA III. 50.7% of colonoscopies were carried out by consultants, 29.85% by nurse endoscopists and 19.45% by specialty doctors. 77.61% of colonoscopies were performed on weekdays and 22.38% during the weekend. WT was not recorded in 20.89% of patients, but the remainder (79.1%) had a mean WT of 15.19 minutes. Pain scores (1–4) were documented as follows: 46.3% none (1), 20.9% mild (2), 8.95% moderate (3), 2.98% severe (4) and not recorded in 20.10%. BP was excellent in 7.46%, good in 40.29%, fair in 36.56%, inadequate in 14.92%, and was not reported in Conclusions Our audit has shown that the target rate of 2% for the PCCRC-3y benchmark was not achieved1. Poor adherence to standard documentation of withdrawal time is likely a contributing factor. Improving documentation and optimising bowel preparation will help to determine if these factors influence PCCRC-3y in future audits. Reference Anderson, R & Burr, N & Valori, R. ( 2020). Causes of post-colonoscopy colorectal cancers based on world endoscopy organization system of analysis. Gastroenterology. 10.1053/j.gastro.2019.12.031.