Combating Post-colonoscopy Colorectal Cancer: Insight from the Trials and Cohort Studies

Colorectal cancer (CRC) remains a significant global health concern, being the third most common cancer and the second leading cause of cancer-related death. A colonoscopy examination is central to CRC prevention, enabling screening and adenoma removal. Nevertheless, the emergence of post-colonoscopy colorectal cancer (PCCRC), which is a CRC diagnosed after a colonoscopy that initially found no malignancy, highlights the critical gaps in the quality of current colonoscopy practices. Missed lesions, particularly those with a non-polypoid morphology or in the proximal colon, are the leading cause of PCCRC, accounting for approximately 80% of cases. Efforts to combat PCCRC focused on enhancing the colonoscopy quality through measurable indicators and developing novel technologies to improve the colonoscopy performance. Evidence of how these interventions are associated with the PCCRC risk is critical for endoscopists to obtain the best efficacy from colonoscopy screening. This review summarizes current clinical studies regarding this issue, focusing on randomized control trials and cohort studies to identify the future direction of clinical research on preventing PCCRC.