If the Right Side of the Colon Deserves Double Examination, so Does the Rectum
Douglas K. Rex, MD, MASGE, reviewing Troelsen FS, et al. Clin Gastroenterol Hepatol 2023 Apr 7.
This study used the World Endoscopy Organization classification of postcolonoscopy colorectal cancer (PCCRC) to assess 762 PCCRC cases that accumulated during 1995 to 2021.
PCCRC was located in the cecum in 15.2% of patients, the ascending colon in 15.7%, and the rectum in 23%. Overall, 81% of PCCRC cases were classified as category A, which is a possible missed lesion with an adequate prior examination (complete to the cecum with good or excellent preparation). The fraction attributed to incomplete resection of a previously identified lesion was 11%, with some reduction over time.
COMMENTThese analyses of PCCRC root cause tend to produce similar results, with the majority of cases attributed to missed lesions, but wide variation between studies in category A (missed lesion with an adequate examination) and category B (missed lesion with an inadequate examination).
I think an important takeaway, also seen in other studies of this type, is that the rectum rivals the right side of the colon as a location for PCCRC. We often now say that routine colonoscopy should include two examinations of the right-sided colon, but overall, the studies indicate the rectum also deserves two full examinations.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Troelsen FS, Sørensen HT, Pedersen L, et al. Root-cause analysis of 762 Danish post-colonoscopy colorectal cancer patients. Clin Gastroenterol Hepatol 2023 Apr 7. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2023.03.034)
