Colorectal cancer (CRC) is the third most common cancer globally and the third most common cause of cancer death. Early diagnosis at stages where disease can be treated, significantly improves survival rates justifying the need for CRC screening programs by ‘gold standard’ colonoscopy. Given the concern for significant numbers of missed lesions, the new JAG Global Rating Scale (GRS) requires all endoscopy units to develop an audit for post-colonoscopy colorectal cancer (PCCRC). Our aim was to provide a template for performing this audit at a major teaching hospital.Methods
We retrospectively reviewed our electronic patient records and collected data on all new CRC diagnoses made over a three-year period (1 st September 2014 – 31 st August 2017). We looked for evidence of colonoscopy performed in the three years prior to diagnosis and applied the following exclusion criteria:Methods
PCCRC rate was defined as the proportion of PCCRC diagnoses amongst all CRC cases. For CRC cases, we also analysed patient demographics, timeframe between colonoscopies and individual endoscopist PCCRC rate.Results
Out of a total 944 CRC cases, 691 were eligible for analysis (Figure 1). There were a total of 12 cases of PCCRC, giving our hospital a PCCRC of 1.74%. The average age of patients with a PCCRC diagnosis was 65.25 years (29–80). The average time between initial and diagnostic colonoscopies in PCCRC cases was 14.33% months (range, 1–34) with initial-to-diagnostic colonoscopies separated by <12 months in 5 cases (41.67%), 12–24 months in 5 cases (41.47%) and >24 months in 2 cases (16.67%). Physician endoscopist miss rate ranged from 0.11%–0.21%.Conclusions
Results from our audit show our hospital is within the BSG, JAG and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) quality assurance target of <5% PCCRC at 3 years. Ideally, endoscopy units will use similar methods for the mandatory JAG GRS audit, allowing comparison between different endoscopy units to improve quality of CRC screening. Our work provides a guidance tool on performing the audit in the hope of achieving this aim.