PTU-031 The world endoscopy organisation consensus statements on post-colonoscopy and post-imaging colorectal cancer

Abstract

Introduction Colonoscopy is an imperfect tool. The term ‘interval’ cancer refers to cancers diagnosed after a colorectal screening examination or test in which no cancer was detected, and before the date of the next recommended exam. From a colonoscopy Quality Assurance perspective, that term is too restrictive, hence the term Post Colonoscopy Colorectal Cancer (PCCRC) was developed, to incorporate non-screening settings. Methods Our goal was to provide a framework on terminology, identification, analysis and reporting of cancers appearing after a negative colonoscopy (PCCRCs) or computed tomographic colonography (Post-Imaging Colorectal Cancers/PICRCs). We based our methodology on the AGREE II tool. A team of gastroenterologists, pathologists, epidemiologists, a radiologist and a patient representative, formed a panel of 20 members. Following literature review, 402 articles provided background for statements, which were then subjected to anonymous voting (modified Delphi approach). The GRADE system was utilised to rate evidence. Results The final output consists of 21 statements, providing guidance on key aspects of PCCRC/PICRC, namely: Definitions/terminology (2 statements) (table 1) Qualitative review of cases/aetiology attribution (8 statements) (figure 1) Quantitative assessment/calculation of PCCRC rate (7 statements) Non–colonoscopic imaging of the colon (4 statements) The PCCRC rate is calculated as the number of PCCRCs divided by the total of the PCCRCs plus the number of detected cancers, expressed as a percentage. A Root-Cause-Analysis checklist, as well as a checklist to assist Peer Review of PCCRC manuscripts have also been developed. Conclusions This is the first consensus aiming to standardise terminology around PCCRC/PICRC, presenting a methodology for analysis of causation of PCCRC/PICRC and defining its potential role as a key quality indicator.