PTH-009 Avoidable factors are identified in 70% of post colonoscopy colorectal cancers (PCCRCS)

Introduction CCRC is cancer arising 6–36 months after a negative colonoscopy. PCCRCs arise from incompletely or unresected lesions, or are missed or new lesions. PCCRC rates are a key quality marker for colonoscopy. The aim of this study was to test the utility of the World Endoscopy Organisation (WEO) algorithm for categorising avoidable factors leading to PCCRC.1 Methods All PCCRCs diagnosed between 01/06/10 and 31/12/16 at one trust were identified by cross-referencing coding and endoscopy data. A root-cause analysis was undertaken for each using the WEO algorithm (figure 1).Abstract PTH-009 Figure 1 Results 27 PCCRCs were reviewed (age 37–85, median 70). 5 patients had inflammatory bowel disease (IBD), 20 diverticulosis and 1 Lynch syndrome. Chromoendoscopy was used in 1 IBD patient. Adenomas had previously been seen in the cancerous bowel segment in 8 cases (29.6%): 3/8 arose from resected lesions; and 5/8 from unresected lesions. 2/5 unresected lesions were deliberately not investigated further (patient/MDT decision). Bowel preparation was poor in 6 colonoscopies (22.2%). 24 were reported as complete, but only 12 had adequate caecal photographs (44.4%). Overall, follow-up procedures were delayed or not requested in 11 cases (40.7%).Abstract PTH-009 Table 1 Distribution of PCCRC origins Conclusions Although the WEO algorithm is a useful tool for PCCRC categorisation, a category for conservatively managed cases is missing. Further, a judgement is still required to conclude whether a PCCRC was avoidable or unavoidable. In this cohort, 70% of PCCRCs (19/27) were probably avoidable; 5 possibly avoidable and 3 likely unavoidable. The following are influencing factors and possible means of addressing them: PCCRC rates are high in patients with existing colon pathology. Rates would reduce in certain groups with greater vigilance and use of chromoendoscopy. Surveillance timeframes were often breached. Effective processes should reduce delays. Bowel preparation was often poor. If these colonoscopies are not repeated, the decision should be recorded. Some adenomas were overlooked while endoscopists focussed on large polyps. Early repeat colonoscopy should be considered after complicated procedures. Photodocumentation was adequate in 44.4% of cases. Inadequate photos may be a marker for other shortcomings and repeat colonoscopy considered if caecal documentation is incomplete. These findings indicate that PCCRC rates could be reduced by up to 70% if avoidable factors are addressed. There is a need for quality improvement studies targeting these factors to quantify their impact on PCCRC rates. References 1. Beintaris I et al. UEG Journal. 2017;5:PO436