Colorectal cancers soon after colonoscopy: a pooled multicohort analysis (original) (raw)
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Gastroenterology, 2007
The rate of new or missed colorectal cancer (CRC) after colonoscopy and their risk factors in usual practice are unknown. Our objective was to evaluate the rate and risk factors in a population-based study. Methods: We analyzed data from the Canadian Institute for Health Information, the Ontario Health Insurance Program, and Ontario Cancer Registry for all patients (>20 years of age) with a new diagnosis of right-sided, transverse, splenic flexure/descending, rectal or sigmoid CRC in Ontario from April 1, 1997 to March 31, 2002, who had a colonoscopy within the 3 years before their diagnosis. Patients with new or missed cancers were those whose most recent colonoscopy was 6 to 36 months before diagnosis. We examined characteristics that might be risk factors for new or missed CRC. Results: We identified a diagnosis of CRC in 3288 (right sided), 777 (transverse), 710 (splenic flexure/ descending), and 7712 (rectal or sigmoid) patients. The rates of new or missed cancers were 5.9%, 5.5%, 2.1%, and 2.3%, respectively. Independent risk factors for these cancers in men and women were older age; diverticular disease; right-sided or transverse CRC; colonoscopy by an internist or family physician; and colonoscopy in an office. Conclusions: Because having an office colonoscopy and certain patient, procedure, and physician characteristics are independent risk factors for new or missed CRC, physicians must inform patients of the small risk (2% to 6%) of these cancers after colonoscopy. The influence of type of physician and setting on the accuracy of colonoscopy, potentially modifiable risk factors, warrants further study.
Postcolonoscopy colorectal cancers are preventable: a population-based study
Gut, 2013
Objective The quality of colonoscopy is key for ensuring protection against colorectal cancer (CRC). We therefore aimed to elucidate the aetiology of postcolonoscopy CRCs (PCCRCs), and especially to identify preventable factors. Methods We conducted a population-based study of all patients diagnosed with CRC in South-Limburg from 2001 to 2010 using colonoscopy and histopathology records and data from the Netherlands Cancer Registry. PCCRCs were defined as cancers diagnosed within 5 years after an index colonoscopy. According to location, CRCs were categorised into proximal or distal from the splenic flexure and, according to macroscopic aspect, into flat or protruded. Aetiological factors for PCCRCs were subdivided into procedure-related (missed lesions, inadequate examination/surveillance, incomplete resection) and biology-related (new cancers). Results We included a total of 5107 patients with CRC, of whom 147 (2.9% of all patients, mean age 72.8 years, 55.1% men) had PCCRCs diagnosed on average 26 months after an index colonoscopy. Logistic regression analysis, adjusted for age and gender, showed that PCCRCs were significantly more often proximally located (OR 3.92, 95% CI 2.71 to 5.69), smaller in size (OR 0.78, 95% CI 0.70 to 0.87) and more often flat (OR 1.70, 95% CI 1.18 to 2.43) than prevalent CRCs. Of the PCCRCs, 57.8% were attributed to missed lesions, 19.8% to inadequate examination/surveillance and 8.8% to incomplete resection, while 13.6% were newly developed cancers. Conclusions In our experience, 86.4% of all PCCRCs could be explained by procedural factors, especially missed lesions. Quality improvements in performance of colonoscopy, with special attention to the detection and resection of proximally located flat precursors, have the potential to prevent PCCRCs.
Complete colonoscopy rarely misses cancer
Gastrointestinal Endoscopy, 2002
The assumption that colonoscopy is highly accurate for detecting colorectal cancer was tested by identifying cancer subsequent to colonoscopy in 2 cohorts of patients in which colonoscopy was reported as normal. Methods: A multicenter endoscopy database was used to identify all reportedly normal colonoscopies. One cohort was assessed 5 years after colonoscopy with the use of a populationbased health services-linked database to link patient morbidity, cancer, and mortality data. The second cohort was assessed by identifying patients who had cancer on repeat colonoscopy. Results: Of 1047 patients with normal colonoscopies followed for 5 years or until death if earlier, 5 cancers (0.5%) were detected. This rate was not significantly different from that predicted by Australian statistics (risk = 1.0%, p > 0.1), but significantly lower compared with that for all patients presenting for colonoscopy during the study period (risk = 5.2%, p < 0.001). In another cohort of 8486 patients with reportedly normal colonoscopies, 496 patients underwent repeat colonoscopies during an average follow-up of 3.1 years; cancer was diagnosed at the subsequent procedure in 3 patients (0.6%). Conclusions: The high accuracy of colonoscopy is demonstrated by the low risk of harboring an advanced neoplastic lesion after a normal examination.
New occurrence and recurrence of neoplasms within 5 years of a screening colonoscopy
The American journal of gastroenterology, 2002
The fear that colorectal adenomas were missed on initial colonoscopy or that new adenomas have developed is often a rationale for repeating a colonoscopic examination. The aim of this study was to delineate risk factors associated with recurrence of colorectal adenomas after an initial baseline screening colonoscopy. The study population comprised 875 subjects who underwent a baseline screening colonoscopy followed by a second examination 1-5 yr later. Multiple logistic regression was used to assess the influence of potential risk factors on the occurrence or recurrence of colorectal adenomas, the strength of the influence being expressed as an OR with a 95% CI. Colorectal adenomas were detected in 484 of all patients (55%) at baseline colonoscopy. Within a 1- to 5-yr time interval, 181 patients (37%) had recurrent adenomas (adenomas were removed during the first colonoscopy) and 73 patients (19%) had newly developed adenomas (adenomas were absent on the first colonoscopy). The occu...
Gastrointestinal endoscopy, 2016
Up to 6% of colorectal cancers (CRCs) are diagnosed within 5 years of a colonoscopy that did not diagnose CRC (post-colonoscopy colorectal cancer, PCCRC). PCCRC and associated risk factors were examined within a national hospital episode database. A retrospective case-control study of all colonoscopies performed on adults recorded in Hospital Episode Statistics (HES) between 2003 and 2009 in England. PCCRC cases underwent colonoscopy 6 to 60 months before diagnosis; controls had not undergone colonoscopy 6 to 60 months before diagnosis. Multivariate logistic regression analysis examined associations with PCCRC. A total of 1,439,684 colonoscopies were analyzed, including 67,202 cases of CRC and 8147 cases of PCCRC (12.1%). Multivariate analysis revealed that female sex (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.08-1.19; P < .001), older age (70-74 years) (OR, 1.09; 95% CI, 1.00-1.18; P = .039), increased comorbidity (Charlson index 5+) (OR, 1.16; 95% CI, 1.05-1.28; P ...
Index colonoscopy-related risk factors for postcolonoscopy colorectal cancers
Gastrointestinal Endoscopy, 2019
Background and Aims:Post-colonoscopy colorectal cancers (PCCRCs) are those detected ≤10 years after an index colonoscopy negative for cancer, but modifiable risk factors are not well established in large, community-based populations.Methods:We evaluated risk factors from the index colonoscopy for PCCRCs diagnosed 1–10 years after an index colonoscopy using a case-control design. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for potential confounders.Results:A ≥10 mm proximal polyp (OR 8.18; 95%CI 4.59, 14.60); ≥10 mm distal polyp (OR 3.30; 95% CI 1.65, 6.58); adenoma with (OR 3.23; 95% CI 1.83, 5.68) and without advanced histology (OR 1.87; 95% CI 1.37, 2.55); and an incomplete colonoscopy (OR 5.52; 95% CI 2.98, 10.21) were associated with PCCRC. Among cases, risk factors for early vs. late cancers (12–36 months vs. >36 months-10 years post-examination) included incomplete polyp excision in the colonic segment of the subsequent cancer (OR 4.76; 95% CI 2.35, 9.65); failure to examine the segment (OR 2.42; 95% CI 1.27, 4.60); and a ≥10 mm polyp in the segment (OR 2.38; 95% CI 1.53, 3.70). A total of 559 of 1206 PCCRC patients (46.4%) had 1 or more risk factors that were significant for PCCRC (incomplete examination, large polyp, or any adenoma).Conclusions:In a large community-based study with comprehensive capture of PCCRCs, almost half of PCCRCs had potentially modifiable factors related to polyp surveillance or removal and exam completeness. These represent potential high-yield targets for further increasing the effectiveness of colorectal cancer screening.
Diseases of the Colon & Rectum, 2000
The aim of this study was to identify the high-risk groups for metachronous colorectal carcinoma among patients who undergo colorectal cancer surgery. METHODS: Three hundred forty-one patients undergoing colorectal cancer surgery who had undergone surveillance colonoscopy at least twice during a period of more than three years were analyzed. A metachronous colorectal carcinoma was defined as a new colorectal carcinoma detected by surveillance colonoscopy after surgery. RESULTS: Surveillance colonoscopy was performed 4.6 times per patient during an average of 6.2 years. Twenty-two metachronous colorectal carcinomas in 19 patients were detected, and 14 (64 percent) of 22 were detected within five years of surgery. The cumulative incidence of developing colorectal carcinomas during a five-year period was 5.3 percent. Seventeen (77 percent) of 22 carcinomas were 10 mm or less in size. Ten (71 percent) of the 14 carcinomas in early stages showed a flat appearance. Univariate analysis showed that extraco-Ionic malignancy, coexistence of adenoma, and synchronous multiple colorectal carcinoma were significant predictive factors for detecting colorectal carcinomas in surveillance colonoscopy and that family history of colorcctal carcinoma was a possible predictive factor. Multivariate analysis perfbrmed with Cox proportional hazards regression model showed that extracolonic malignancy and the coexistence of adenoma were significant predictive factors. CONCLUSION: We recommend that patients with the above predictive factors receive surveillance colonoscopy meticulously mad regularly. [
The Journal of Medical Investigation, 2016
This is a single-center, retrospective study of prospectively collected data from April 2010 to September 2013. Data were obtained from the endoscopic database in Kyoto Second Red Cross Hospital, Kyoto, Japan. Consecutive colonoscopies performed during this period were included in this study. Informed consent was obtained from all individual participants in the study, and the study protocol was approved by the institutional review board of Kyoto Second Red Cross Hospital and conducted in accordance with the Declaration of Helsinki (as revised in Tokyo, 2004). Patients were excluded from our analysis based on the following criteria : inflammatory bowel diseases, familial adenomatous polyposis, colonoscopy within 6 months, unknown history of previous colonoscopy, and unknown family history. We analyzed the differences in morphological characteristics and location of advanced neoplasms between