Wilson Natalie, Bilal Mohammad, Westanmo Anders, Karna Rahul, Gravely Amy, Shaukat Aasma
Department of Internal Medicine, University of Minnesota, Minneapolis, MN.
Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO.
Am J Gastroenterol. 2025 Jul 7. doi: 10.14309/ajg.0000000000003635.
Post-colonoscopy colorectal cancer (PCCRC) represents an important real-world colonoscopy quality indicator. Using a national database, we evaluated predictors of PCCRC in fecal immunochemical test (FIT)-positive individuals, determined the PCCRC 3-year rate (PCCRC-3y), and performed a root cause analysis (RCA).
This retrospective cohort study evaluated FIT-positive patients who underwent colonoscopy from January 2015 to July 2022. Data was collected from the Veterans Affairs (VA) national database. PCCRC was defined as CRC detected ≥6 months after colonoscopy. CRC was identified using SNOMED codes and the VA Cancer Registry. The World Endoscopy Organization methodology was used to perform the RCA and calculate the PCCRC-3y rate.
We identified 132 PCCRCs among 52,167 FIT-positive individuals. The PCCRC-3y rate was 6.4% (95% CI, 5.0-7.7%). PCCRC locations were proximal colon (43.2%), distal colon (34.8%), and rectum (22%). Root causes were likely new CRC (17.4%), missed lesions with adequate (31.2%) or inadequate (9.8%) examination, incomplete polyp resection (22%), and detected but unresected lesions (19.7%). 16.7% of patients with PCCRC had poor bowel preparation on index colonoscopy. The cecal intubation rate was 88.6% and rectal retroflexion rate was 84.5%. In 14.4% of cases, recommended surveillance intervals did not adhere to established guidelines. Independent predictors of PCCRC were ages 70-79 (HR 7.86; 95% CI, 1.08-57.39), age ≥80 (HR 10.18; 95% CI, 1.06-97.98), tubulovillous adenoma (HR 3.98; 95% CI, 2.52-6.29), and adenoma with high-grade dysplasia (HR 10.15; 95% CI, 5.91-17.42).
Among FIT-positive individuals, the PCCRC-3y rate was 6.4%, with missed lesions and incomplete resection as key contributors. These findings provide useful information on quality metrics in FIT-based CRC screening programs.
结肠镜检查后结直肠癌（PCCRC）是一项重要的现实世界结肠镜检查质量指标。我们利用国家数据库评估了粪便免疫化学检测（FIT）阳性个体中PCCRC的预测因素，确定了PCCRC的3年发生率（PCCRC-3y），并进行了根本原因分析（RCA）。
这项回顾性队列研究评估了2015年1月至2022年7月接受结肠镜检查的FIT阳性患者。数据从退伍军人事务部（VA）国家数据库收集。PCCRC定义为结肠镜检查后≥6个月检测到的结直肠癌。使用SNOMED编码和VA癌症登记处识别结直肠癌。采用世界内镜组织的方法进行根本原因分析并计算PCCRC-3y发生率。
我们在52167名FIT阳性个体中识别出132例PCCRC。PCCRC-3y发生率为6.4%（95%CI，5.0-7.7%）。PCCRC的位置为近端结肠（43.2%）、远端结肠（34.8%）和直肠（22%）。根本原因可能是新发结直肠癌（17.4%）、检查充分（31.2%）或不充分（9.8%）时漏诊病变、息肉切除不完全（22%）以及检测到但未切除的病变（19.7%）。16.7%的PCCRC患者首次结肠镜检查时肠道准备不佳。盲肠插管率为88.6%，直肠反转率为84.5%。在
