Root-cause analysis of 762 post-colonoscopy colorectal cancers diagnosed in the Central Denmark Region, 1995-2021

Aims Occurrence of post-colonoscopy colorectal cancer (PCCRC) is an important benchmark of colonoscopy quality. We examined causes of PCCRCs using the root-cause analysis suggested by the World Endoscopy Organization (WEO) and investigated the potential impact of implementing FIT-based colorectal cancer screening on PCCRC causes.

Methods During 1995-2021 within the Central Denmark Region, we used health registries and electronic medical records to identify PCCRC cases, defined as a first-time colorectal cancer diagnosis recorded within 6-48 months after colonoscopy. We then applied the WEO algorithm to categorize causes of PCCRC as follows: A) possible missed lesion, prior examination adequate; B) possible missed lesion, prior examination inadequate; C) detected lesion, not resected; or D) likely incomplete resection of previously identified lesion.

Results We identified 762 PCCRC patients. In total, 53.5% were males and the majority were aged 70-79 years. Forty-five percent of PCCRCs were located in the proximal colon. Of all PCCRCs during the complete study period, 616 (80.8%) were categorized as A) possible missed lesion, prior examination adequate; 36 (4.7%) as B) possible missed lesion, prior examination inadequate; 26 (3.4%) as C) detected lesion, not resected; and 84 (11%) as D) likely incomplete resection of previously identified lesion. Similar patterns were observed before and after implementation of the screening program for colorectal cancer in 2014.

Conclusions Both before and after implementation of screening, PCCRCs originating from possible missed lesions were the most common. These findings indicate the importance of the quality of colonoscopy procedures.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
14 April 2023