CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(03): 301-307
DOI: 10.1055/s-0041-1730014
Review Article

Postcolonoscopy Colorectal Cancer: An Overview and Future Directions

1   Department of General Surgery, Division of Surgery, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
1   Department of General Surgery, Division of Surgery, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
› Institutsangaben


Over the past decade, there has been a great interest in postcolonoscopy colorectal cancer (PCCRC). Its etiology is complex and multifactorial. Monitoring for PCCRC is even more complex. The strategies to decrease the incidence of PCCRC start by defining the problem, identifying the factors contributing to its development, followed by an attempt to define methods to decrease its incidence. We believe that the quality of the colonoscopy and the endoscopist's expertise are the key factors in decreasing the incidence of PCCRC.


Eingereicht: 22. Juni 2020

Angenommen: 15. Januar 2021

Artikel online veröffentlicht:
19. Juli 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

  • References

  • 1 Sanduleanu S, le Clercq CM, Dekker E. et al; Expert Working Group on 'Right-sided lesions and interval cancers', Colorectal Cancer Screening Committee, World Endoscopy Organization. Definition and taxonomy of interval colorectal cancers: a proposal for standardising nomenclature. Gut 2015; 64 (08) 1257-1267
  • 2 Haseman JH, Lemmel GT, Rahmani EY, Rex DK. Failure of colonoscopy to detect colorectal cancer: evaluation of 47 cases in 20 hospitals. Gastrointest Endosc 1997; 45 (06) 451-455
  • 3 Baxter NN, Sutradhar R, Forbes SS, Paszat LF, Saskin R, Rabeneck L. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology 2011; 140 (01) 65-72
  • 4 Singh H, Nugent Z, Demers AA, Bernstein CN. Rate and predictors of early/missed colorectal cancers after colonoscopy in Manitoba: a population-based study. Am J Gastroenterol 2010; 105 (12) 2588-2596
  • 5 Sanduleanu S, Masclee AM, Meijer GA. Interval cancers after colonoscopy-insights and recommendations. Nat Rev Gastroenterol Hepatol 2012; 9 (09) 550-554
  • 6 Singh S, Singh PP, Murad MH, Singh H, Samadder NJ. Prevalence, risk factors, and outcomes of interval colorectal cancers: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109 (09) 1375-1389
  • 7 Brenner H, Chang-Claude J, Seiler CM, Stürmer T, Hoffmeister M. Does a negative screening colonoscopy ever need to be repeated?. Gut 2006; 55 (08) 1145-1150
  • 8 Singh H, Turner D, Xue L, Targownik LE, Bernstein CN. Risk of developing colorectal cancer following a negative colonoscopy examination: evidence for a 10-year interval between colonoscopies. JAMA 2006; 295 (20) 2366-2373
  • 9 Brenner H, Chang-Claude J, Seiler CM, Hoffmeister M. Interval cancers after negative colonoscopy: population-based case-control study. Gut 2012; 61 (11) 1576-1582
  • 10 Iacopetta B. Are there two sides to colorectal cancer?. Int J Cancer 2002; 101 (05) 403-408
  • 11 Shamsuddin AM, Phelps PC, Trump BF. Human large intestinal epithelium: light microscopy, histochemistry, and ultrastructure. Hum Pathol 1982; 13 (09) 790-803
  • 12 Arai T, Kino I. Morphometrical and cell kinetic studies of normal human colorectal mucosa. Comparison between the proximal and the distal large intestine. Acta Pathol Jpn 1989; 39 (11) 725-730
  • 13 Sawhney MS, Farrar WD, Gudiseva S. et al. Microsatellite instability in interval colon cancers. Gastroenterology 2006; 131 (06) 1700-1705
  • 14 Nishihara R, Wu K, Lochhead P. et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369 (12) 1095-1105
  • 15 Arain MA, Sawhney M, Sheikh S. et al. CIMP status of interval colon cancers: another piece to the puzzle. Am J Gastroenterol 2010; 105 (05) 1189-1195
  • 16 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81 (01) 31-53
  • 17 Hilsden RJ, Dube C, Heitman SJ, Bridges R, McGregor SE, Rostom A. The association of colonoscopy quality indicators with the detection of screen-relevant lesions, adverse events, and postcolonoscopy cancers in an asymptomatic Canadian colorectal cancer screening population. Gastrointest Endosc 2015; 82 (05) 887-894
  • 18 Kaminski MF, Wieszczy P, Rupinski M. et al. Increased rate of adenoma detection associates with reduced risk of colorectal Cancer and death. Gastroenterology 2017; 153 (01) 98-105
  • 19 Gellad ZF, Weiss DG, Ahnen DJ, Lieberman DA, Jackson GL, Provenzale D. Colonoscopy withdrawal time and risk of neoplasia at 5 years: results from VA Cooperative Studies Program 380. Am J Gastroenterol 2010; 105 (08) 1746-1752
  • 20 Cheung D, Evison F, Patel P, Trudgill N. Factors associated with colorectal cancer occurrence after colonoscopy that did not diagnose colorectal cancer. Gastrointest Endosc 2016; 84 (02) 287-295.e1
  • 21 Van Heijningen EMB, Lansdorp-Vogelaar I, Steyerberg EW. et al. Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study. Gut 2015; 64 (10) 1584-1592 DOI: 10.1136/gutjnl-2013-306453.
  • 22 Technology status report evaluation. Endoscopic mucosal resection. Gastrointest Endosc 2000; 52 (06) 860-863
  • 23 Karita M, Tada M, Okita K, Kodama T. Endoscopic therapy for early colon cancer: the strip biopsy resection technique. Gastrointest Endosc 1991; 37 (02) 128-132
  • 24 Yokota T, Sugihara K, Yoshida S. Endoscopic mucosal resection for colorectal neoplastic lesions. Dis Colon Rectum 1994; 37 (11) 1108-1111
  • 25 Oka S, Tanaka S, Saito Y. et al; Colorectal Endoscopic Resection Standardization Implementation Working Group of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol 2015; 110 (05) 697-707
  • 26 Robertson DJ, Greenberg ER, Beach M. et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology 2005; 129 (01) 34-41
  • 27 Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol 2007; 102 (04) 856-861
  • 28 Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 1992; 326 (10) 658-662
  • 29 Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 2007; 132 (01) 96-102
  • 30 Subramaniam K, Ang PW, Neeman T, Fadia M, Taupin D. Post-colonoscopy colorectal cancers identified by probabilistic and deterministic linkage: results in an Australian prospective cohort. BMJ open 2019; 9: e026138-e026138
  • 31 Tutticci NJ, Hewett DG, Leggett BA. Prevalence of serrated polyps: implications for significance as colorectal cancer precursors. Colorectal Cancer 2013; 2: 535-547
  • 32 Anderson JC, Butterly LF, Robinson CN, Mackenzie T. Higher Serrated Detection Rate Is Associated With Lower Risk for Post-Colonoscopy Colorectal Cancer. Am J Gastroenterol 2019; 114 (Supplement): S137
  • 33 Burgess NG, Tutticci NJ, Pellise M, Bourke MJ. Sessile serrated adenomas/polyps with cytologic dysplasia: a triple threat for interval cancer. Gastrointest Endosc 2014; 80 (02) 307-310
  • 34 Higuchi T, Sugihara K, Jass JR. Demographic and pathological characteristics of serrated polyps of colorectum. Histopathology 2005; 47 (01) 32-40
  • 35 Longacre TA, Fenoglio-Preiser CM. Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia. Am J Surg Pathol 1990; 14 (06) 524-537
  • 36 Bettington M, Walker N, Rosty C. et al. Critical appraisal of the diagnosis of the sessile serrated adenoma. Am J Surg Pathol 2014; 38 (02) 158-166
  • 37 Olén O, Erichsen R, Sachs MC. et al. Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study. Lancet 2020; 395 (10218): 123-131
  • 38 Beaugerie L, Itzkowitz SH. Cancers complicating inflammatory bowel disease. N Engl J Med 2015; 372 (15) 1441-1452
  • 39 Beaugerie L, Svrcek M, Seksik P. et al; CESAME Study Group. Risk of colorectal high-grade dysplasia and cancer in a prospective observational cohort of patients with inflammatory bowel disease. Gastroenterology 2013; 145 (01) 166-175.e8
  • 40 Choi PM, Zelig MP. Similarity of colorectal cancer in Crohn's disease and ulcerative colitis: implications for carcinogenesis and prevention. Gut 1994; 35 (07) 950-954
  • 41 Nugent FW, Haggitt RC, Gilpin PA. Cancer surveillance in ulcerative colitis. Gastroenterology 1991; 100 (5 Pt 1): 1241-1248
  • 42 Rozen P, Baratz M, Fefer F, Gilat T. Low incidence of significant dysplasia in a successful endoscopic surveillance program of patients with ulcerative colitis. Gastroenterology 1995; 108 (05) 1361-1370
  • 43 Farraye FA, Odze RD, Eaden J. et al; AGA Institute Medical Position Panel on Diagnosis and Management of Colorectal Neoplasia in Inflammatory Bowel Disease. AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology 2010; 138 (02) 738-745
  • 44 Lamb CA, Kennedy NA, Raine T. et al; IBD guidelines eDelphi consensus group. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019; 68 (Suppl. 03) s1-s106
  • 45 Itzkowitz SH, Present DH. Crohn's and Colitis Foundation of America Colon Cancer in IBD Study Group. Consensus conference: Colorectal cancer screening and surveillance in inflammatory bowel disease. Inflamm Bowel Dis 2005; 11 (03) 314-321
  • 46 Van Assche G, Dignass A, Bokemeyer B. et al; European Crohn's and Colitis Organisation. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 3: special situations. J Crohn's Colitis 2013; 7 (01) 1-33
  • 47 Ananthakrishnan AN, Cagan A, Cai T. et al. Colonoscopy is associated with a reduced risk for colon cancer and mortality in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol 2015; 13 (02) 322-329.e1
  • 48 Choi CH, Rutter MD, Askari A. et al. Forty-Year Analysis of Colonoscopic Surveillance Program for Neoplasia in Ulcerative Colitis: An Updated Overview. Am J Gastroenterol 2015; 110 (07) 1022-1034
  • 49 Mattar MC, Lough D, Pishvaian MJ, Charabaty A. Current management of inflammatory bowel disease and colorectal cancer. Gastrointest Cancer Res 2011; 4 (02) 53-61
  • 50 Annese V, Beaugerie L, Egan L. et al; ECCO. European Evidence-based Consensus: Inflammatory Bowel Disease and Malignancies. J Crohn's Colitis 2015; 9 (11) 945-965
  • 51 Laine L, Kaltenbach T, Barkun A, McQuaid KR, Subramanian V, Soetikno R. SCENIC Guideline Development Panel. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology 2015; 148 (03) 639-651.e28
  • 52 Cairns SR, Scholefield JH, Steele RJ. et al; British Society of Gastroenterology, Association of Coloproctology for Great Britain and Ireland. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59 (05) 666-689
  • 53 Wang YR, Cangemi JR, Loftus Jr EV, Picco MF. Rate of early/missed colorectal cancers after colonoscopy in older patients with or without inflammatory bowel disease in the United States. Am J Gastroenterol 2013; 108 (03) 444-449
  • 54 Mooiweer E, van der Meulen-de Jong AE, Ponsioen CY. et al; Dutch Initiative on Crohn's and Colitis. Incidence of Interval Colorectal Cancer Among Inflammatory Bowel Disease Patients Undergoing Regular Colonoscopic Surveillance. Clin Gastroenterol Hepatol 2015; 13 (09) 1656-1661
  • 55 Rutter MD, Saunders BP, Wilkinson KH. et al. Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis. Gastroenterology 2006; 130 (04) 1030-1038
  • 56 Sanduleanu S, Rutter MD. Interval colorectal cancers in inflammatory bowel disease: the grim statistics and true stories. Gastrointest Endosc Clin N Am 2014; 24 (03) 337-348
  • 57 Mecklin JP, Aarnio M, Läärä E. et al. Development of colorectal tumors in colonoscopic surveillance in Lynch syndrome. Gastroenterology 2007; 133 (04) 1093-1098
  • 58 de Vos tot Nederveen Cappel WH, Nagengast FM, Griffioen G. et al. Surveillance for hereditary nonpolyposis colorectal cancer: a long-term study on 114 families. Dis Colon Rectum 2002; 45 (12) 1588-1594
  • 59 Engel C, Rahner N, Schulmann K. et al; German HNPCC Consortium. Efficacy of annual colonoscopic surveillance in individuals with hereditary nonpolyposis colorectal cancer. Clin Gastroenterol Hepatol 2010; 8 (02) 174-182
  • 60 Newton K, Green K, Lalloo F, Evans DG, Hill J. Colonoscopy screening compliance and outcomes in patients with Lynch syndrome. Colorectal Dis 2015; 17 (01) 38-46
  • 61 Haanstra JF, Vasen HF, Sanduleanu S. et al. Quality colonoscopy and risk of interval cancer in Lynch syndrome. Int J Colorectal Dis 2013; 28 (12) 1643-1649
  • 62 Richter JM, Pino MS, Austin TR. et al. Genetic mechanisms in interval colon cancers. Dig Dis Sci 2014; 59 (09) 2255-2263
  • 63 Cheung KS, Chen L, Chan EW, Seto WK, Wong ICK, Leung WK. Nonsteroidal anti-inflammatory drugs but not aspirin are associated with a lower risk of post-colonoscopy colorectal cancer. Aliment Pharmacol Ther 2020; 51 (09) 899-908
  • 64 Rutter MD, Beintaris I, Valori R. et al. World Endoscopy Organization Consensus Statements on Post-Colonoscopy and Post-Imaging Colorectal Cancer. Gastroenterology 2018; 155 (03) 909-925.e3