CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(05): E717-E727
DOI: 10.1055/a-0751-2660
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Post-colonoscopy colorectal cancer in Belgium: characteristics and influencing factors

Elisabeth Macken
1   Gastroenterology & Hepatology, Antwerp University Hospital, Edegem, Antwerp, Belgium
Stefan Van Dongen
2   Evolutionary Ecology Group, Department of Biology, University of Antwerp, Antwerp, Belgium
Isabel De Brabander
3   Belgian Cancer Registry, Brussels, Belgium
Sven Francque
1   Gastroenterology & Hepatology, Antwerp University Hospital, Edegem, Antwerp, Belgium
Ann Driessen
4   Pathology, Antwerp University Hospital, Edegem, Antwerp, Belgium
Guido Van Hal
5   Medical Sociology and Health Policy, University of Antwerp, Antwerp, Belgium
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submitted 30. Mai 2018

accepted after revision 04. September 2018

08. Mai 2019 (online)


Background and study aims Post-colonoscopy colorectal cancer (PCCRC) is an important quality parameter of colonoscopy. Most studies have shown that the risk for colorectal cancer is reduced after an index colonoscopy for screening or diagnostic purposes with or without polypectomy. In this study, we aimed to quantify and describe PCCRC in Belgium, including the possible relationships with patient, physician, and colonoscopy characteristics.

Patients and methods Reimbursement data on colorectal related medical procedures from the Intermutualistic Agency (IMA-AIM) were linked with data on clinical and pathological staging of colorectal cancer (CRC) available at the Belgian Cancer Registry (BCR) over a period covering 9 years (2002 – 2010).

Results In total, 63 518 colorectal cancers were identified in 61 616 patients between 2002 and 2010. We calculated a mean PCCRC rate of 7.6 %. PCCRC was significantly higher in older people and correlated significantly with polyp detection rate and the number of resections and procedures performed per year per physician. Conditional observed survival, given still alive 3 years since first colonoscopy, for PCCRC was worse than for CRC. Older patients and patients with invasive carcinomas had a worse outcome.

Conclusions Although no quality register exists in Belgium, we were able to demonstrate that PCCRC in Belgium is directly related to the experience of the physician performing the procedure. In the absence of a quality register, utilization of population-based data sources proved to be a valuable tool to identify quality parameters.

  • References

  • 1 Winawer SJ, Zauber AG, Ho MN. et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. NEJM 1993; 329: 1977-1981
  • 2 Brenner H, Chang-Claude J, Seiler CM. et al. Protection from colorectal cancer after colonoscopy: a population-based, case-control study. Ann Intern Med 2011; 154: 22-30
  • 3 Nishihara R, Wu K, Lochhead P. et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. NEJM 2013; 369: 1095-1105
  • 4 Pan J, Xin L, Ma YF. et al. Colonoscopy reduces colorectal cancer incidence and mortality in patients with non-malignant findings: a meta-analysis. Am J Gastroenterol 2016; 111: 355-365
  • 5 Zauber AG, Winawer SJ, O’Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. NEJM 2012; 366: 687-696
  • 6 Samadder NJ, Curtin K, Tuohy TM. et al. Characteristics of missed or interval colorectal cancer and patient survival: a population-based study. Gastroenterology 2014; 146: 950-960
  • 7 Robertson DJ, Lieverman DA, Winawer SJ. et al. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut 2014; 63: 949-956
  • 8 Morris EJ, Rutter MD, Finan PJ. et al. Post-colonoscopy colorectal cancer (PCCRC) rates vary considerably depending on the method used to calculated them: a retrospective observational population-based study of PCCRC in the English National Health Service. Gut 2015; 64: 1248-1256
  • 9 Rutter MC, Beintaris I, Valori R. et al. World Endoscopy Organization Consensus Statements on Post-Colonoscopy and Post-Imaging Colorectal Cancer. Gastroenterology 2018; 155: 909-925.e3
  • 10 Hsu J. Stepwise multiple comparisons with the best. J Stat Plan Interf 1992; 33: 197-204
  • 11 Macken E, Van Dongen S, Francque S. et al. Parameters influencing the quality of colonoscopy in Belgium: a critical evaluation. Acta Gastroenterol Belg 2018; 81: 29-38
  • 12 Cheung D, Evison F, Patel P. et al. Factors associated with colorectal cancer occurrence after colonoscopy that did not diagnose colorectal cancer. Gastrointest Endosc 2016; 84: 287-295
  • 13 Erichsen R, Baron JA, Stoffel EM. et al. Characteristics and survival of interval and sporadic colorectal cancer patients: a nationwide population-based cohort study. Am J Gastroenterol 2013; 108: 1332-1340
  • 14 Cooper GS, Xu F, Barnholts Sloan JS. et al. Prevalence and predictors of interval colorectal cancers in medicare beneficiaries. Cancer 2012; 118: 3044-3052
  • 15 Bressler B, Paszat LF, Chen Z. et al. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 2007; 132: 96-102
  • 16 Baxter NN, Sutradhar E, Forbes SS. et al. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology 2011; 140: 65-72
  • 17 Tadros M, Anderson JC. Serrated polyps: clinical implications and future directions. Curr Gastroenterol Rep 2013; 15: 342
  • 18 Govindarajan A, Rabeneck L, Yun L. et al. Population-based assessment of the outcomes in patients with postcolonoscopy colorectal cancers. Gut 2016; 65: 971-976
  • 19 Nakshabendi R, Berry AC, Munoz JC. et al. Choice of sedation and its impact on adenoma detection rate in screening colonoscopies. Ann Gastroenterol 2016; 29: 50-55
  • 20 Lee SW, Chang JH, Ji JS. et al. Effect of dynamic position changes on adenoma detection during colonoscope withdrawal: a randomized controlled multicenter trial. Am J Gastroenterol 2016; 111: 63-69
  • 21 Chilton A, Rutter M. , editors Quality Assurance Guidelines for Colonoscopy. NHS BCSP Publication No 6. NHS Cancer Screening Programmes, Fulwood House; 2011 Available from: ; Accessed 11 August 2018
  • 22 Gill MD, Bramble MG, Rees CJ. et al. Comparisons of screen-detected and interval colorectal cancers in the Bowel Cancer Screening Programme. Br J Cancer 2012; 107: 417-421
  • 23 Farrar WD, Sawhney MS, Nelson DB. et al. Colorectal cancers found after complete colonoscopy. Clin Gastroenterol Hepatol 2006; 4: 1259-1264
  • 24 Rex DK, Ponugoti PL. Calculating the adenoma detection rate in screening colonoscopies only: Is it necessary? Can it be gamed?. Endoscopy 2017; 49: 1069-1074