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Postcolonoscopy colorectal cancer: how low can we go?
  1. Colin Rees1,
  2. E Dekker2
  1. 1Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
  2. 2Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Professor Colin Rees, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK; colin.rees{at}newcastle.ac.uk

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Postcolonoscopy colorectal cancers (PCCRCs) are CRCs occurring between 6 months and 3 years after an index colonoscopy.1 Significant variation in PCCRC rates exist between endoscopy units (3.2%–16.4%).2 British Society of Gastroenterology standards advise that all units should develop a system for capturing data on PCCRCs and for investigating these cases by root cause analysis (RCA) and should aim for a PCCRC rate of less than 5% at 3 years.3

A number of factors are known to be associated with PCCRC including patients at increased risk which include those with inflammatory bowel disease (IBD), diverticular disease, those who are female, older and those with comorbidity.1 PCCRCs are also associated with endoscopists with low adenoma detection rate (ADR), where resections of lesions are incomplete and in certain types of lesion morphology such as subtle, flat, depressed and serrated lesions, particularly in the proximal colon.

The study by Ahmad et al undertook RCA of all potential cases of PCCRC within one large, expert centre in the UK.4 Having sifted out incorrect inclusion of cases, 58 were true PCCRCs. The main factors associated with PCCRC were possible missed lesions, inadequate procedures and not resected or incompletely resected lesions. New or rapidly growing lesions have been proposed elsewhere to be a potential explanation for PCCRCs and guidance proposes undertaking Microsatellite Instability testing on all PCCRCs.1 It is very interesting to note, however, that none of the …

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Footnotes

  • Contributors The manuscript was written by CR and ED and agreed by both authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CR has received grant funding from medtronic, norgine, Olympus and ARC medical. He was an expert witness for ARC medical and Olympus.

  • Provenance and peer review Commissioned; internally peer reviewed.