Post-colonoscopy Colorectal Cancer Research Articles

Closing the gap for post-colonoscopy colorectal cancer

Colonoscopy is key in the diagnosis, prevention, and treatment of colorectal cancer. This technique allows the full examination of the colonic mucosa and resection of most pre-neoplastic lesions. However, as with any observer-dependent procedure, colonoscopy has limitations. In this sense, post-colonoscopy colorectal cancer is a well-described entity, and accounts for up to 8·2% of incident colorectal cancer cases.1 Post-colonoscopy colorectal cancer is associated with endoscopists' ability to evaluate the colonic mucosa and resect colonic lesions.

Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study

Adenoma detection rate (ADR) is a well-established quality indicator for colonoscopy and is inversely associated with the incidence of interval post-colonoscopy colorectal cancer. However, interval post-colonoscopy colorectal cancers frequently develop from serrated polyps, which are not included in the ADR. Therefore, the proximal serrated polyp detection rate (PSPDR) has been proposed as a quality indicator, but its association with interval post-colonoscopy colorectal cancer has not been studied. We aimed to evaluate this potential association based on data collected in the Dutch colorectal cancer screening programme. In this population-based study, using colonoscopy data from the Dutch faecal immunochemical test-based colorectal cancer screening programme and cancer data from the Netherlands Cancer Registry, we evaluated the association between endoscopists' individual PSPDR and their patients' risk of interval post-colonoscopy colorectal cancer with a shared frailty Cox proportional-hazard regression analysis. Participants in the screening programme who were eligible for inclusion were aged 55-76 years, had a positive faecal immunochemical test (cutoff 15 μg Hb/g faeces at start and changed mid-2014 to 47 μg Hb/g faeces), were asymptomatic, and underwent a colonoscopy between Jan 1, 2014, and Dec 31, 2020. The PSPDR was defined as the proportion of colonoscopies in which at least one serrated polyp proximal to the descending colon was detected, confirmed by histopathology. The ADR was defined as the proportion of all colonoscopies in which at least one conventional adenoma was detected, confirmed by histopathology. Detection rates were determined for each endoscopist individually. We additionally evaluated the risk of interval post-colonoscopy colorectal cancer for endoscopists with a PSPDR and ADR above the median versus endoscopists with either one or both parameters below the median. This study is registered with the Netherlands Trial Registry, NL8350. During the study period, 329 104 colonoscopies were done, of which 277 555, done by 441 endoscopists, were included in the PSPDR calculations. The median PSPDR was 11·9% (IQR 8·3-15·8) and median ADR was 66·3% (61·4-69·9). The correlation between the PSDPR and ADR was moderate (r=0·59; p<0·0001). During a median follow-up of 33 months (IQR 21-42), 305 interval post-colonoscopy colorectal cancers were detected. For each percentage point increase in PSPDR, the adjusted interval post-colonoscopy colorectal cancer hazard was 7% lower (hazard ratio [HR] 0·93, 95% CI 0·90-0·95; p<0·0001). Compared with endoscopists with a PSPDR greater than 11·9% and ADR greater than 66·3%, the HR of interval post-colonoscopy colorectal cancer for endoscopists with a low PSPDR and high ADR was 1·79 (95% CI 1·22-2·63), for endoscopists with a high PSPDR and low ADR was 1·97 (1·19-3·24), and for endoscopists with a low PSPDR and low ADR was 2·55 (1·89-3·45). The PSPDR of an endoscopist is inversely associated with the incidence of interval post-colonoscopy colorectal cancer. Implementation of PSPDR monitoring, in addition to ADR monitoring, could optimise colorectal cancer prevention. None.

Automated Detection of Bowel Preparation Scoring and Adequacy With Deep Convolutional Neural Networks.

Adequate bowel preparation is integral to effective colonoscopy. Inadequate bowel preparation has been associated with reduced adenoma detection rate and increased post-colonoscopy colorectal cancer (PCCRC). As a result, the USMSTF recommends early interval reevaluation for colonoscopies with inadequate bowel preparation. However, bowel preparation documentation is highly variable with subjective interpretation. In this study, we developed deep convolutional neural networks (DCNN) to objectively ascertain bowel preparation. Bowel preparation scores were assigned using the Boston Bowel Preparation Scale (BBPS). Bowel preparation adequacy and inadequacy were defined as BBPS ≥2 and BBPS <2, respectively. A total of 38523 images were extracted from 28 colonoscopy videos and split into 26966 images for training, 7704 for validation, and 3853 for testing. Two DCNNs were created using a Densenet-169 backbone in PyTorch library evaluating BBPS score and bowel preparation adequacy. We used Adam optimiser with an initial learning rate of 3 × 10-4 and a scheduler to decay the learning rate of each parameter group by 0.1 every 7 epochs along with focal loss as our criterion for both classifiers. The overall accuracy for BBPS subclassification and determination of adequacy was 91% and 98%, respectively. The accuracy for BBPS 0, BBPS 1, BBPS 2, and BBPS 3 was 84%, 91%, 85%, and 96%, respectively. We developed DCCNs capable of assessing bowel preparation adequacy and scoring with a high degree of accuracy. However, this algorithm will require further research to assess its efficacy in real-time colonoscopy.

Strengths and Weaknesses of an Artificial Intelligence Polyp Detection Program as Assessed by a High-Detecting Endoscopist

Strengths and Weaknesses of an Artificial Intelligence Polyp Detection Program as Assessed by a High-Detecting Endoscopist

Post-endoscopy Barrett's neoplasia after a negative index endoscopy: a systematic review and proposal for definitions and performance measures in endoscopy.

A high rate of neoplasia, both high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) has been reported in Barrett's esophagus at index endoscopy, but precise rates of post-endoscopy Barrett's neoplasia (PEBN) are unknown. A systematic review and meta-analysis was performed examining electronic databases (inception to October 2021) for studies reporting PEBN. Consistent with the definitions of post-colonoscopy colorectal cancer proposed by the World Endoscopy Organization, we defined neoplasia (HGD/EAC) detected at index endoscopy and/or within 6 months of a negative index endoscopy as "prevalent" neoplasia, that detected after 6 months of a negative index endoscopy and prior to next surveillance interval (i. e. 3 years) as PEBN or "interval" neoplasia, and that detected after 36 months from a negative index endoscopy as "incident" neoplasia. The pooled incidence rates and proportions relative to total neoplasia were analyzed. 11 studies (n = 59 795; 61 % men; mean [SD] age 62.3 [3.3] years) met the inclusion criteria. The pooled incidence rates were: prevalent neoplasia 4.5 % (95 %CI 2.2 %-8.9 %) at baseline and an additional 0.3 % (0.1 %-0.7 %) within the first 6 months, PEBN 0.52 % (0.46 %-0.58 %), and incident neoplasia 1.4 % (0.9 %-2.1 %). At 3 years from the index endoscopy, PEBN accounted for 3 % of total Barrett's neoplasia, while prevalent neoplasia accounted for 97 %. Neoplasia detected at or within 6 months of index endoscopy accounts for most cases of Barrett's neoplasia (> 90 %). PEBN accounts for ~3 % of cases and can be used for validation in future. This highlights the importance of a high quality index endoscopy in Barrett's esophagus and the need to establish quality benchmarks to measure endoscopists' performance.

Efficacy of international web-based educational intervention in the detection of high-risk flat and depressed colorectal lesions higher (CATCH project) with a video: Randomized trial.

ObjectivesThree subcategories of high‐risk flat and depressed lesions (FDLs), laterally spreading tumors non‐granular type (LST‐NG), depressed lesions, and large sessile serrated lesions (SSLs), are highly attributable to post‐colonoscopy colorectal cancer (CRC). Efficient and organized educational programs on detecting high‐risk FDLs are lacking. We aimed to explore whether a web‐based educational intervention with training on FIND clues (fold deformation, intensive stool/mucus attachment, no vessel visibility, and demarcated reddish area) may improve the ability to detect high‐risk FDLs.MethodsThis was an international web‐based randomized control trial that enrolled non‐expert endoscopists in 13 Asian countries. The participants were randomized into either education or non‐education group. All participants took the pre‐test and post‐test to read 60 endoscopic images (40 high‐risk FDLs, five polypoid, 15 no lesions) and answered whether there was a lesion. Only the education group received a self‐education program (video and training questions and answers) between the tests. The primary outcome was a detection rate of high‐risk FDLs.ResultsIn total, 284 participants were randomized. After excluding non‐responders, the final data analyses were based on 139 participants in the education group and 130 in the non‐education group. The detection rate of high‐risk FDLs in the education group significantly improved by 14.7% (66.6–81.3%) compared with −0.8% (70.8–70.0%) in the non‐education group. Similarly, the detection rate of LST‐NG, depressed lesions, and large SSLs significantly increased only in the education group by 12.7%, 12.0%, and 21.6%, respectively.ConclusionShort self‐education focusing on detecting high‐risk FDLs was effective for Asian non‐expert endoscopists. (UMIN000042348).

Clinically significant serrated polyp detection rates and risk for postcolonoscopy colorectal cancer: data from the New Hampshire Colonoscopy Registry

Higher adenoma detection rates reduce the risk of postcolonoscopy colorectal cancer (PCCRC). Clinically significant serrated polyps (CSSPs; defined as any sessile serrated polyp, traditional serrated adenoma, large [≥1 cm] or proximal hyperplastic polyp >5mm) also lead to PCCRC, but there are no data on associated CSSP detection rates (CSSDRs). We used data from the New Hampshire Colonoscopy Registry (NHCR) to investigate the association between PCCRC risk and endoscopist CSSDR. We included NHCR patients with 1 or more follow-up events: either a colonoscopy or a colorectal cancer (CRC) diagnosis identified through linkage with the New Hampshire State Cancer Registry. We defined our outcome, PCCRC, in 3 time periods: CRC diagnosed 6 to 36 months, 6 to 60 months, or all examinations (6 months or longer) after an index examination. We excluded patients with CRC diagnosed at or within 6 months of the index examination, with incomplete examinations, or with inflammatory bowel disease. The exposure variable was endoscopist CSSDR at the index colonoscopy. Cox regression was used to model the hazard of PCCRC on CSSDR controlling for age, sex, index findings, year of examination, personal history of colorectal neoplasia, and having more than 1 surveillance examination. One hundred twenty-eight patients with CRC diagnosed at least 6 months after their index examination were included. Our cohort included 142 endoscopists (92 gastroenterologists). We observed that the risk for PCCRC 6 months or longer after the index examination was significantly lower for examinations performed by endoscopists with CSSDRsof 3% to<9% (hazard ratio [HR], .57; 95% confidence interval [CI], .39-.83) or 9% or higher (HR, .39; 95% CI, .20-.78) relative to those with CSSDRs under 3%. Our study is the first to demonstrate a lower PCCRC risk after examinations performed by endoscopists with higher CSSDRs. Both CSSDRs of 9% and 3% to<9% had statistically lower risk of PCCRC than CSSDRs of<3%. These data validate CSSDR as a clinically relevant quality measure for endoscopists.

A120 AUTOMATED BOWEL PREPARATION DETECTION WITH DEEP. CONVOLUTIONAL NEURAL NETWORKS

BackgroundIntroduction: Bowel preparation inadequacy has been shown to increase post-colonoscopy colorectal cancer. As such, the USMSTF recommends repeating colonoscopy within 1 year if bowel preparation is inadequate. However, bowel preparation documentation is variable in clinical practice, and physician recommendations adherent to USMTF guidelines are inconsistent.AimsAims: We present an automated computer assisted method using deep convolutional neural networks to detect bowel preparation and adequacy of bowel preparation with the Boston Bowel Preparation Scale (BBPS).MethodsMethods: We extracted 38523 images of colonic lumen between 2015 and 2017 from screening colonoscopies. Bowel preparation scores were assessed with BBPS. Adequate bowel preparation was defined as BBPS ≥2, and inadequate bowel preparation was defined as BBPS <2. The dataset was split into 26966 images for training, 7704 for validation, and 3853 for testing. Training data was sampled with replacement from a multinomial distribution to balance subclass distributions in each batch. We developed 2 convoluted neural networks (CNN) using PyTorch with a Densenet-169 backbone pre-trained on ImageNet and fine-tuned on our data for classifying adequacy of bowel preparation (binary) and for subclassification of BBPS (multi-class). We used Adam optimiser with an initial learning rate of 3x10-4 and a scheduler to decay the learning rate of each parameter group by 0.1 every 7 epochs along with focal loss as our criterion for both classifiers.ResultsResults: The overall accuracy on the test data set for BBPS subclassification was 0.91. The sensitivity for BBPS 0, 1, 2 and 3 were 0.84, 0.91, 0.86, and 0.96, respectively. The specificity for BBPS 0, 1, 2, and 3 were 1.00, 0.98, 0.95, and 0.93, respectively. The overall accuracy of the test data set for adequacy of bowel preparation was 0.97. The sensitivity for adequacy of bowel preparation for BBPS <2 and BBPS ≥2 was 0.92 and 0.99, respectively. The specificity for adequacy of bowel preparation for BBPS <2 and BBPS ≥2 was 0.99 and 0.92, respectively.Conclusions Conclusion: We present an automated computer-assisted detection method of bowel preparation with deep convolutional neural networks. The algorithm is capable of accurate classification of adequacy of bowel preparation (97%) and subclassification of bowel preparation (91%) with high sensitivity and specificity. This algorithm can be applied to automate documentation of bowel preparation and adequacy of bowel preparation. Additional studies will need to be conducted to demonstrate its applicability in real-time colonoscopy.Funding AgenciesNone

Validation of post-colonoscopy colorectal cancer (PCCRC) cases reported at national level following local root cause analysis: REFLECT study

ObjectiveOur aim was to determine aetiology of post-colonoscopy colorectal cancers (PCCRCs) identified from population-based data through local root cause analysis at a high-volume mixed secondary and tertiary referral centre.Design/methodA subset...

Patient and Endoscopic Characteristics of Postcolonoscopy Colon Cancer-A Case-control Study.

Colonoscopy is imperfect for colorectal cancer (CRC) prevention. Postcolonoscopy CRC (PCCRC) is defined as CRC detected after a screening or surveillance colonoscopy. PCCRCs can be divided into noninterval CRC and interval CRC. We performed a case-control study to identify risk factors for PCCRCs and to compare risks between noninterval and interval PCCRCs. We designed a retrospective case-control study. Using a Vermont tumor registry data set, we identified all PCCRCs diagnosed at our medical center from January 2012 to September 2017. Cases were matched 1:3 with controls of the same age, sex, and index colonoscopy date. Fifty-four PCCRCs were matched with 162 controls and divided into noninterval (N= 27) and interval (N= 27) subsets. Overall PCCRC risk and noninterval PCCRC risk were significantly associated with history of polyps (odds ratio [OR] PCCRC= 2.71, OR noninterval= 4.41), sessile serrated polyps (OR PCCRC= 3.94, OR noninterval= 5.79), and high-risk adenoma (HRA) (OR PCCRC= 6.58, OR noninterval= 16.46) and with the index colonoscopy having a large polyp (OR PCCRC= 4.45, OR noninterval= 10.46) or having an HRA (OR PCCRC= 3.68, OR noninterval= 8.04). PCCRC risk and interval PCCRC risk were significantly associated with follow-up recommendations that did not correlate with American Gastroenterological Association surveillance guidelines (OR PCCRC= 3.30, OR interval= 4.85). Approximately 30% ofPCCRCs could be attributed to endoscopic quality. Overall PCCRC risk and noninterval PCCRC risk were significantly associated with traditional CRC risk factors including precancerous polyps and HRA on the index colonoscopy. Interval PCCRC was not associated with these risk factors. Many PCCRCs can be attributed to endoscopic quality, and nonadherence to CRC surveillance guidelines may be a novel risk factor.

Colonoscopy quality and endoscopist factors: what are the required endoscopist conditions for high-quality colonoscopy to reduce colorectal cancer incidence and mortality?

To maximize the effectiveness of colonoscopy in decreasing the incidence and mortality of colorectal cancer (CRC), high-quality colonoscopy procedures are essential. Considering that the colonoscopy quality varies among endoscopists, it is important to understand the endoscopist factors that influence the colonoscopy quality. In this paper, we reviewed the endoscopist factors related to colonoscopy quality. There are several quality indicators of colonoscopy, among which the adenoma detection rate is the most established indicator with evidence of its correlation with post-colonoscopy CRC. With respect to lesion detectability during colonoscopy, there are other measurements such as the sessile serrated lesion detection rate; however, further evidence on their relationships with post-colonoscopy CRC is needed. Previous studies that have examined the endoscopist characteristics influencing colonoscopy quality have suggested that several factors, including experience, the volume of colonoscopy procedures, and endoscopist specialty, are related to lesion detectability. However, discrepancies exist regarding the studies’ results; in particular, the influence of endoscopist specialty on coloscopy quality is controversial. Some recent studies have demonstrated that endoscopist specialty is not related to lesion detectability when considering confounding factors. Furthermore, it has been reported that nurse endoscopists can provide high-quality colonoscopy after training. It may be possible for endoscopists to improve their colonoscopy quality, regardless of specialty. Training, monitoring, and feedback of colonoscopy quality measurements are useful interventions for endoscopists to ensure high-quality procedures. Owing to the continuous development of endoscopic technologies, it is believed that training is useful for both inexperienced and experienced endoscopists.

Narrow-band Imaging With a New Imaging Processor Can Detect Color Difference of Colorectal Polyps

An increased adenoma detection rate (ADR) at colonoscopy decreases the risk of postcolonoscopy colorectal cancer.1 Narrow-band imaging (NBI) is a blue-light technology that enhances visualization of superficial mucosal structures, especially superficial micro-capillaries.2 Adenomas have increased vascularity and in NBI look brown against a blue-green normal background mucosa, whereas serrated polyps are relatively hypovascular and look pale. The newly launched EVIS X1 endoscopy system provides images with a higher resolution and higher brightness, and thus could potentially improve polyp visibility.

Can Real-time Computer-Aided Detection Systems Diminish the Risk of Postcolonoscopy Colorectal Cancer?

The adenoma detection rate is the constant subject of research and the main marker of quality in bowel cancer screening. However, by improving the quality of endoscopy via artificial intelligence methods, all polyps, including those with the potential for malignancy, can be removed, thereby reducing interval colorectal cancer rates. As such, the removal of all polyps may become the best marker of endoscopy quality. Thus, we present a viewpoint on integrating the computer-aided detection (CADe) of polyps with high-accuracy, real-time colonoscopy to challenge quality improvements in the performance of colonoscopy. Colonoscopy for bowel cancer screening involving the integration of a deep learning methodology (ie, integrating artificial intelligence with CADe systems) has been assessed in an effort to increase the adenoma detection rate. In this viewpoint, a few studies are described, and their results show that CADe systems are able to increase screening sensitivity. The detection of adenomatous polyps, which are associated with a potential risk of progression to colorectal cancer, and their removal are expected to reduce cancer incidence and mortality rates. However, so far, artificial intelligence methods do not increase the detection of cancer or large adenomatous polyps but contribute to the detection of small precancerous polyps.

Molecular pathways in post-colonoscopy versus detected colorectal cancers: results from a nested case-control study.

Post-colonoscopy colorectal cancers (PCCRCs) pose challenges in clinical practice. PCCRCs occur due to a combination of procedural and biological causes. In a nested case-control study, we compared clinical and molecular features of PCCRCs and detected CRCs (DCRCs). Whole-genome chromosomal copy number changes and mutation status of genes commonly affected in CRC were examined by low-coverage WGS and targeted sequencing, respectively. MSI and CIMP status was also determined. In total, 122 PCCRCs and 98 DCRCs with high-quality DNA were examined. PCCRCs were more often located proximally (P < 0.001), non-polypoid appearing (P = 0.004), early stage (P = 0.009) and poorly differentiated (P = 0.006). PCCRCs showed significantly less 18q loss (FDR < 0.2), compared to DCRCs. No significant differences in mutations were observed. PCCRCs were more commonly CIMP high (P = 0.014) and MSI (P = 0.029). After correction for tumour location, only less 18q loss remained significant (P = 0.005). Molecular features associated with the sessile serrated lesions (SSLs) and non-polypoid colorectal neoplasms (CRNs) are more commonly seen in PCCRCs than in DCRCs. These together with the clinical features observed support the hypothesis that SSLs and non-polypoid CRNs are contributors to the development of PCCRCs. The future focus should be directed at improving the detection and endoscopic removal of these non-polypoid CRN and SSLs. NTR3093 in the Dutch trial register ( www.trialregister.nl ).

Risk of a post-colonoscopy colorectal cancer in patients with type 2 diabetes: a Danish population-based cohort study

ObjectivePrevalent type 2 diabetes (T2D) is associated with an increased risk of colorectal cancer and could impair the quality of bowel preparation for colonoscopy. This may in turn increase the...

The Incidence, Distribution and Clinicopathology of Missed Colorectal Cancer After Diagnostic Colonoscopy.

Colonoscopy does miss some lesions that may be later diagnosed as post-colonoscopy colorectal cancers (PCCRCs). We evaluated the rate of PCCRCs in a cohort of our patients. The data of patients diagnosed with first primary colorectal cancers (CRCs) between July 2014 and June 2017 were analyzed. Colorectal cancers were considered to be missed if they occurred among patients who have had an index colonoscopy between 7 and 36 months prior to their diagnosis. The incidence of missed lesions and the distribution of such lesions in the large bowel are presented. In the study, 399 of the total 541 patients whose CRCs were diagnosed by colonoscopy were included. The median age of the patients (213 males and 186 females) was 75.3 (32.4-82.1) years. Seven patients with diagnosis of primary CRCs had undergone index colonoscopy between 7 and 36 months prior to their diagnostic colonoscopy. Therefore, the PCCRC rate in this cohort was 1.8% (7/399 × 100). The mean time interval between the false negative colonoscopy (index colonoscopy) and diagnostic colonoscopy was 18.7 (9.1- 34.9) months. Missed CRCs were located in the ascending (2), transverse (1), descending (1), and sigmoid colon (2) and in the rectum (1). Our PCCRC rate was 1.8%, which is lower than the usually reported rate.

Serrated polyps and polyposis of the colon: a brief review for surgeon endoscopists.

SummarySerrated polyps (SPs) were once considered benign, clinically unimportant lesions. However, it is now recognized that through the serrated neoplasia pathway (SNP), SPs play a role in the development of 15%–30% of cases of colorectal cancers (CRC). Furthermore, a high proportion of postcolonoscopy CRCs are believed to arise from SNP. Serrated polyps are classified into hyperplastic polyps, sessile serrated lesions, sessile serrated lesions with dysplasia, traditionally serrated adenomas, and unclassified serrated adenoma, each with a distinct morphological and molecular profile. Despite improved understanding, SPs remain a clinical challenge owing to evolving terminology, frequent pathologic misclassification, endoscopic underdetection, and high rates of incomplete removal. Surgeon endoscopists and surgeons who perform colorectal procedures will undoubtedly come across patients with SPs, and this paper summarizes some of the clinical challenges they will encounter. We also discuss the diagnosis and management of patients with serrated polyposis syndrome (SPS).

Automated detection of cecal intubation with variable bowel preparation using a deep convolutional neural network.

Background and study aims Colonoscopy completion reduces post-colonoscopy colorectal cancer. As a result, there have been attempts at implementing artificial intelligence to automate the detection of the appendiceal orifice (AO) for quality assurance. However, the utilization of these algorithms has not been demonstrated in suboptimal conditions, including variable bowel preparation. We present an automated computer-assisted method using a deep convolutional neural network to detect the AO irrespective of bowel preparation. Methods A total of 13,222 images (6,663 AO and 1,322 non-AO) were extracted from 35 colonoscopy videos recorded between 2015 and 2018. The images were labelled with Boston Bowel Preparation Scale scores. A total of 11,900 images were used for training/validation and 1,322 for testing. We developed a convolutional neural network (CNN) with a DenseNet architecture pre-trained on ImageNet as a feature extractor on our data and trained a classifier uniquely tailored for identification of AO and non-AO images using binary cross entropy loss. Results The deep convolutional neural network was able to correctly classify the AO and non-AO images with an accuracy of 94 %. The area under the receiver operating curve of this neural network was 0.98. The sensitivity, specificity, positive predictive value, and negative predictive value of the algorithm were 0.96, 0.92, 0.92 and 0.96, respectively. AO detection was > 95 % regardless of BBPS scores, while non-AO detection improved from BBPS 1 score (83.95 %) to BBPS 3 score (98.28 %). Conclusions A deep convolutional neural network was created demonstrating excellent discrimination between AO from non-AO images despite variable bowel preparation. This algorithm will require further testing to ascertain its effectiveness in real-time colonoscopy.

SP1.1.6Incidence of post colonoscopy colorectal cancer, are we compliant with national guidelines?

Abstract Aims To investigate the incidence of post colonoscopy colorectal cancer (PCCRC) at a district NHS trust and assess compliance with UK key performance indicators and quality assurance standards for colonoscopy guidelines endorsed by JAG and the ACPGBI Methods We conducted a retrospective review of our trust colorectal MDT database to identify patients diagnosed with colorectal cancer in the period between January 2016 till June 2019 who underwent a colonoscopy within 6-36 month prior to their diagnosis with colorectal cancer. Patient demographics, indication of colonoscopy, date of cancer diagnosis, procedure related factors such as quality of bowel preparation, presence of diverticular disease, prior history of inflammatory bowel disease, previously diagnosed polyps and also grade of endoscopist were extrapolated. Results 1323 patients were diagnosed with colorectal cancer during the study period, out of these there were 111 patients who underwent a colonoscopy within 6-36 month prior to their diagnostic colonoscopy. After exclusion of cases with anastomotic recurrence (n = 2) and cases with no PCCRC (n = 82), there were 27 patients with confirmed PCCRC in accordance with WEO classification (PCCRC 2.8%, acceptable target 5%) Upon review of the 27 cases with PCCRC, there was equal gender distribution while the majority were 71-80 years old. There was evidence of diverticular disease in 44% and previous colonic polyps in 48%. The quality of bowel preparation was recorded as good in 25 cases while grade of endoscopist was consultant (n = 24), associate specialist (n = 1), nurse endoscopist (n = 2) Conclusions The incidence of PCCRC in our trust falls within national guidelines.

Post-endoscopy Esophageal Neoplasia in Barrett’s Esophagus: Consensus Statements From an International Expert Panel

Post-endoscopy Esophageal Neoplasia in Barrett’s Esophagus: Consensus Statements From an International Expert Panel