Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences (Toronto) and ICES uOttawa, Ontario, Canada.
Institute for Clinical Evaluative Sciences (Toronto) and ICES uOttawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.
Gastrointest Endosc. 2018 May;87(5):1324-1334.e4. doi: 10.1016/j.gie.2017.12.027. Epub 2018 Jan 6.
Colorectal cancers (CRCs) diagnosed between 6 and 36 months after colonoscopy, termed postcolonoscopy CRCs (PCCRCs), arise primarily due to missed or inadequately treated neoplasms during colonoscopy. Introduction of multiple quality indicators and technological advances to colonoscopy practice should have reduced the PCCRC rate over time. We assessed temporal trends in the population rate of PCCRC as a measure of changing colonoscopy quality.
We conducted a population-based retrospective cohort study of persons aged 50 to 74 years without advanced risk factors for CRC who underwent complete colonoscopy in Ontario, Canada between 1996 and 2010. We defined the PCCRC rate as the proportion of individuals diagnosed with CRC within 36 months of colonoscopy that had PCCRC. We compared age-adjusted and sex-adjusted rates of PCCRC over time based on 3 periods (1996-2001, 2001-2006 and 2006-2010) and assessed the independent association between time period and PCCRC risk through multivariable regression, with respect to all PCCRCs, proximal PCCRC and distal PCCRC.
There was a marked increase in colonoscopy volumes over the study period, particularly in younger age groups and non-hospital settings. Among 1,093,658 eligible persons the PCCRC rate remained stable at approximately 8% over the 15-year study period. The adjusted odds of PCCRC, distal PCCRC and proximal PCCRC, comparing the 2006 to 2010 period with the 1996 to 2001 period, were 1.14 (95% confidence interval [CI], 1.0-1.31), 1.11 (95% CI, 0.91-1.34), and 1.14 (95% CI, 0.94-1.38), respectively. Temporal trends in PCCRC risk did not differ by endoscopist specialty or institutional setting after covariate adjustment.
The PCCRC rate in Ontario has remained consistently high over time. Widespread initiatives are needed to improve colonoscopy quality.
结肠镜检查后 6 至 36 个月内诊断出的结直肠癌（CRC），称为结肠镜检查后结直肠癌（PCCRC），主要是由于结肠镜检查期间漏诊或治疗不充分的肿瘤引起的。引入多个质量指标和技术进步，应该会随着时间的推移降低 PCCRC 率。我们评估了作为衡量结肠镜检查质量变化的指标的人群中 PCCRC 的发生率随时间的变化趋势。
我们对 1996 年至 2010 年间在加拿大安大略省接受完全结肠镜检查的 50 至 74 岁无结直肠癌高危因素的人群进行了一项基于人群的回顾性队列研究。我们将 PCCRC 率定义为结肠镜检查后 36 个月内诊断为 CRC 的个体中患有 PCCRC 的比例。我们根据 3 个时期（1996-2001 年、2001-2006 年和 2006-2010 年）比较了随时间变化的年龄和性别调整后的 PCCRC 率，并通过多变量回归评估了时期与所有 PCCRC、近端 PCCRC 和远端 PCCRC 的 PCCRC 风险之间的独立关联。
在研究期间，结肠镜检查数量显著增加，尤其是在年轻人群和非医院环境中。在 1093658 名合格人群中，15 年研究期间，PCCRC 率保持在 8%左右。与 1996 年至 2001 年期间相比，2006 年至 2010 年期间 PCCRC、远端 PCCRC 和近端 PCCRC 的调整后比值比（95%置信区间[CI]，1.0-1.31）分别为 1.14（95%CI，0.91-1.34）、1.11（95%CI，0.91-1.34）和 1.14（95%CI，0.94-1.38）。调整协变量后，PCCRC 风险的时间趋势不因内镜医师专业或医疗机构设置而异。
安大略省的 PCCRC 率随时间保持稳定居高不下。需要采取广泛的举措来提高结肠镜检查质量。
