The potential impact of screening colonoscopy quality on post colonoscopy colorectal cancer: An analysis of linked...

Evidence suggests that improving polyp detection rates may reduce the risk of post-colonoscopy colorectal cancer (PCCRC). This study aimed to assess the impact of key performance indicators amongst screening colonoscopists on the future risk of advanced polyps and colorectal cancer diagnoses within 3-years of screening colonoscopy.

This was a retrospective cohort study of patients undergoing screening colonoscopy. Endpoints of advanced polyps or colorectal cancer were identified by analysis of linked healthcare data through the Secure Anonymised Information Linkage Databank. A multivariate Cox regression analysis assessed the impact of colonoscopist's key performance indicators on the outcomes.

5807 patients were included, with a median follow-up of 60.1 months. There were 0.9% (n = 51) interval advanced polyps and 0.5% (n = 27) colorectal cancers identified with a median time to diagnosis of 19.8 and 39.2 months, respectively. PCCRC rate was 3.8%. The median colonoscopist polyp detection rates were 62.2% with an adenoma detection rate of 50.9%. There was minimal variation in outcomes of advanced polyp or colorectal cancer diagnoses within this group of screening colonoscopists, with no impact demonstrated of increasing improvement of the assessed key performance indicators on this.

It appears there may not be a relationship between increasing performance indicators and better clinical outcomes within this group of high performing colonoscopists. It is likely this will vary depending on the study population and pre test probability of disease. This knowledge may contribute to identifying thresholds that may be utilised in training, surveillance recommendations, new technology and screening programmes.