PCCRC Cases Identified Using Population-Based Data May Be Re-Classified As Detected Cancers When Local Data Is Used To Perform A Root Cause Analysis

Aims A recent population-based cohort study showed variation in post-colonoscopy colorectal cancer (PCCRC) rates across providers. Aim: to analyse PCCRC cases using local data in order to determine the cause and evaluate whether clinician and/or patient factors are primarily responsible.

Methods A retrospective root cause analysis was performed, in accordance with World Endoscopy Organisation recommendations, on a sample of 52 cases reported as PCCRCs from a national dataset (CORECT-R) during 2005-2013. 6 cases were excluded (3 missing data, 3 duplicates).

First, we confirmed if the case was a true PCCRC and if so, the most plausible explanation. We then evaluated whether responsibility for the PCCRC was primarily due to clinician and/or patient factors.

Results Of 46 included cases, 35 were confirmed as PCCRCs. 11 cases did not meet the PCCRC definition (8 detected cancers, 3 data errors).

The mean age for PCCRCs was 68 years old (range 39-93). The primary endoscopist was an independent non-consultant endoscopist, consultant, or nurse endoscopist in 51.4 % (18/35), 45.7 % (16/35), and 2.9 % (1/35) of cases respectively. Caecal intubation was reported in 94.3 % (33/35) of cases with adequate caecal photodocumentation in 54.3 % (19/35) of cases (reviewed by two blinded endoscopists). Rectal retroflexion was performed in 42.9 % (15/35) of cases.

Table 1 Breakdown of most plausible explanation for confirmed PCCRC cases and primary responsibility

Most plausible explanation	Clinician responsible	Clinician and Patient responsible	Patient responsible	Total
Possible missed lesion, prior examination adequate	4	0	0	4 (11.4 %)
Possible missed lesion, prior examination negative but inadequate	12	1	0	13 (37.1 %)
Detected lesion, not resected	4	4	4	12 (34.3 %)
Likely incomplete resection of previously identified lesion	6	0	0	6 (17.1 %)

Primary responsibility for the PCCRC cases was in 74.3 % (26/35) the clinician, 11.4 % (4/35) the patient (surgery refused) and 14.3 % (5/35) both clinician and patient.

Conclusions Local data helps confirm and evaluate PCCRC cases identified from national datasets. Clinician-factors were responsible for the majority of PCCRC cases. Lack of caecal and rectal retroflexion photodocumentation occurred frequently in PCCRC cases and may be a marker of suboptimal examination. In a significant proportion of cases where a lesion was detected patients refused surgery which ultimately led to the PCCRC.

Citation Ahmad A ¹, Humphries A¹, Dhillon A et al. eP125 PCCRC CASES IDENTIFIED USING POPULATION-BASED DATA MAY BE RE-CLASSIFIED AS DETECTED CANCERS WHEN LOCAL DATA IS USED TO PERFORM A ROOT CAUSE ANALYSIS. Endoscopy 2021; 53: S137.

Publication History

Article published online:
19 March 2021