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UEG Week's latest research
Post-colonoscopy colorectal cancer (PCCRC) refers to colorectal cancer diagnosed months or years after the initial colonoscopy is negative, and its incidence accounts for approximately 3 to 7 percent of all CRCs [1].
PCCRC is a hot spot in the field of early screening of colorectal cancer in recent years, and its clinical characteristics, causes and preventive measures are all issues
of great concern to clinicians.
In UEG Week 2022, Professor Zsófia Bősze from the University of Szeged in Hungary gave an in-depth discussion
on PCCRC-related issues.
"Medical community" specially invited Dr.
Xia Bihan from the Department of Gastroenterology, West China Hospital of Sichuan University to bring us a wonderful conference report
.
How is the study done?
Prof.
Zsófia Bősze shared a single-center retrospective study conducted by her team of patients diagnosed with CRC at Seged University between January 1, 2010 and December 31, 2021, with inclusion criteria of diagnosis of CRC within five years of colonoscopy, with the objectives of understanding the incidence of PCCC at the institution, determining the clinical features and predictors of PCC, and assessing patient compliance with PCCRC-related follow-up or monitoring guidelines
。
Incidence of PCCRC
During this 12-year period, a total of 3310 patients were diagnosed with CRC in the institution, of which 138 (4.
17%) patients were diagnosed with PCCRC
.
The highest number of patients diagnosed with CRC in 2016 may be related to a colorectal cancer screening pilot project launched that year; In addition, the base of colonoscopy may be reduced due to the impact of the new coronavirus, and the number of patients diagnosed with CRC and PCCRC in 2020 is the lowest
.
The incidence of PCCC in this institution ranges from 2% to 7%, which is generally consistent with international data (Figure 1).
Figure 1
When PCCRC is defined based on diagnosis obtained within 1, 3, or 5 years after colonoscopy, its incidence varies
.
In 2018, the incidence of PCCRC corresponding to the three years reached the highest value; The incidence of PCCRC was lowest in 2020 when the age limit was set to 5 or 3 years, and the lowest incidence in 2013 when the age limit was set to 1 year (Figure 2).
Figure 2
Clinical features in patients with PCCRC
In TNM staging, the overall malignancy of PCCRC was lower than that of CRC
.
Specifically, about 3/4 and 1/2 of patients with CRC and PCCRC belong to stage T3 or T4, respectively; about 1/2 and 1/4 of patients develop lymph node metastases; and about 26% and 16% of patients have distant metastases (Figure 3).
Figure 3
Common causes of PCCC include missed lesions, lesions that have not been completely removed, and new lesions
.
In this institution, missed lesions are the most common cause of PCRC occurrence every year, accounting for 70.
29% of the total number of PCCRC patients; Incomplete lesion resection and new lesions accounted for 19.
57% and 10.
14% of the total number of PCCRC patients, respectively (Figure 4).
It is worth noting that missed diagnosis of lesions and incomplete resection of lesions can actually be improved by improving the quality of initial colonoscopy, that is, about 80% of PCCRC is likely to be "killed" in the
cradle.
Figure 4
The indicators that evaluate the quality of initial colonoscopy mainly include Boston bowel preparation score (BBPS), cecal intubation, withdrawal time, etc
.
More than 80% of the included participants had adequate or moderate bowel preparation, and the success rate of cecal intubation was 70%, but most of the withdrawal time was missing (this has been routinely recorded by the institution since 2019) (Figure 5).
Figure 5
Compliance with PCCRC-related follow-up or monitoring guidelines
According to the initial colonoscopy, the speaker team divided PCCRC patients into five subgroups: polypectomy group, inflammatory bowel disease (IBD) group, CRC patient group, colonoscopy screening group, and FAP group
.
Among them, more than half of patients with initial colonoscopy for polyps or IBD followed the guideline recommended monitoring interval recommendations for reexamination, compared with less than half in the CRC group2–4 (Figure 6).
Overall, two-thirds of PCCRC patients follow the monitoring intervals recommended by authoritative guidelines, so there is still the potential for one-third of patients to avoid PCCRC by strictly following the monitoring intervals
.
Figure 6
total
knot
The study of Professor Zsófia Bősze's team found that the TNM stage of patients with PCRC was slightly earlier than that of patients with CRC, confirming that missed diagnosis of lesions was the most common cause of PCCRC.
In addition, to prevent the occurrence of PCCRC, Professor Zsófia Bősze's team believes that two important points are to improve the quality of initial colonoscopy and urge patients to strictly follow the colonoscopy monitoring intervals
recommended by authoritative guidelines.
Liu with it
Postdoctoral Fellow/Assistant Researcher, Department of Gastroenterology, West China Hospital, Sichuan University, MD
.Graduated from West China Clinical Medical College of Sichuan University, he is currently working in the Department of Gastroenterology, West China Hospital, Sichuan University/Sichuan University-Oxford University West China Joint Research Center for Digestive Tract Tumors, focusing on clinical diagnosis and treatment and basic research
of early gastrointestinal tumors.He has published many SCI papers in the field of digestion as the first author and co-first author (Gastroenterology, American Journal of Gastroenterology, etc.
).He is currently a member of the Ultrasound Endoscopy Branch of
Sichuan Endoscopy Technology Association.
References:
[1] Md R, I B, R V, et al.
World Endoscopy Organization Consensus Statements on Post-Colonoscopy and Post-Imaging Colorectal Cancer.
Gastroenterology.
2018; 155(3).
doi:10.
1053/j.
gastro.
2018.
05.
038
[2] Hassan C, Antonelli G, Dumonceau JM, et al.
Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020.
Endoscopy.
2020; 52(8):687-700.
doi:10.
1055/a-1185-3109
[3] Ak S, Jr L, Dh B, et al.
The role of endoscopy in inflammatory bowel disease.
Gastrointestinal endoscopy.
2015; 81(5).
doi:10.
1016/j.
gie.
2014.
10.
030
[4] Hassan C, Wysocki PT, Fuccio L, et al.
Endoscopic surveillance after surgical or endoscopic resection for colorectal cancer: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Digestive Oncology (ESDO ) Guideline.
Endoscopy.
2019; 51(3):266-277.
doi:10.
1055/a-0831-2522