PTH-009 Avoidable factors are identified in 70% of post colonoscopy colorectal cancers (PCCRCS)

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Abstract

Introduction

CCRC is cancer arising 6–36 months after a negative colonoscopy. PCCRCs arise from incompletely or unresected lesions, or are missed or new lesions. PCCRC rates are a key quality marker for colonoscopy. The aim of this study was to test the utility of the World Endoscopy Organisation (WEO) algorithm for categorising avoidable factors leading to PCCRC.1

Methods

All PCCRCs diagnosed between 01/06/10 and 31/12/16 at one trust were identified by cross-referencing coding and endoscopy data. A root-cause analysis was undertaken for each using the WEO algorithm (figure 1).

Results

27 PCCRCs were reviewed (age 37–85, median 70). 5 patients had inflammatory bowel disease (IBD), 20 diverticulosis and 1 Lynch syndrome. Chromoendoscopy was used in 1 IBD patient. Adenomas had previously been seen in the cancerous bowel segment in 8 cases (29.6%): 3/8 arose from resected lesions; and 5/8 from unresected lesions. 2/5 unresected lesions were deliberately not investigated further (patient/MDT decision). Bowel preparation was poor in 6 colonoscopies (22.2%). 24 were reported as complete, but only 12 had adequate caecal photographs (44.4%). Overall, follow-up procedures were delayed or not requested in 11 cases (40.7%).

Conclusions

Although the WEO algorithm is a useful tool for PCCRC categorisation, a category for conservatively managed cases is missing. Further, a judgement is still required to conclude whether a PCCRC was avoidable or unavoidable. In this cohort, 70% of PCCRCs (19/27) were probably avoidable; 5 possibly avoidable and 3 likely unavoidable. The following are influencing factors and possible means of addressing them:

Conclusions

These findings indicate that PCCRC rates could be reduced by up to 70% if avoidable factors are addressed. There is a need for quality improvement studies targeting these factors to quantify their impact on PCCRC rates.

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