Background and Aims

Colorectal cancers (CRCs) diagnosed between 6 and 36 months after colonoscopy, termed postcolonoscopy CRCs (PCCRCs), arise primarily due to missed or inadequately treated neoplasms during colonoscopy. Introduction of multiple quality indicators and technological advances to colonoscopy practice should have reduced the PCCRC rate over time. We assessed temporal trends in the population rate of PCCRC as a measure of changing colonoscopy quality.

Methods

We conducted a population-based retrospective cohort study of persons aged 50 to 74 years without advanced risk factors for CRC who underwent complete colonoscopy in Ontario, Canada between 1996 and 2010. We defined the PCCRC rate as the proportion of individuals diagnosed with CRC within 36 months of colonoscopy that had PCCRC. We compared age-adjusted and sex-adjusted rates of PCCRC over time based on 3 periods (1996-2001, 2001-2006 and 2006-2010) and assessed the independent association between time period and PCCRC risk through multivariable regression, with respect to all PCCRCs, proximal PCCRC and distal PCCRC.

Results

There was a marked increase in colonoscopy volumes over the study period, particularly in younger age groups and non-hospital settings. Among 1,093,658 eligible persons the PCCRC rate remained stable at approximately 8% over the 15-year study period. The adjusted odds of PCCRC, distal PCCRC and proximal PCCRC, comparing the 2006 to 2010 period with the 1996 to 2001 period, were 1.14 (95% confidence interval [CI], 1.0-1.31), 1.11 (95% CI, 0.91-1.34), and 1.14 (95% CI, 0.94-1.38), respectively. Temporal trends in PCCRC risk did not differ by endoscopist specialty or institutional setting after covariate adjustment.

Conclusion

The PCCRC rate in Ontario has remained consistently high over time. Widespread initiatives are needed to improve colonoscopy quality.

中文翻译：

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50至74岁人群结肠镜检查后结肠直肠癌发生率的时间趋势：一项基于人群的研究

背景和目标

结肠镜检查后6到36个月之间诊断出的结肠直肠癌（CRC），称为结肠镜检查后CRC（PCCRC），主要是由于结肠镜检查过程中缺少或未充分治疗的肿瘤引起的。随着时间的推移，多项质量指标的引入和结肠镜检查实践的技术进步应该降低了PCCRC的发生率。我们评估了PCCRC人口率的时空趋势，作为改变结肠镜检查质量的一项指标。

方法

我们对1996年至2010年之间在加拿大安大略省接受了完全结肠镜检查的50岁至74岁无CRC晚期危险因素的人群进行了一项基于人群的回顾性队列研究。我们将PCCRC率定义为在36岁以内被诊断为CRC的个体所占的比例进行PCCRC的结肠镜检查数月。我们根据3个时期（1996-2001年，2001-2006年和2006-2010年）比较了随时间变化的PCCRC的年龄调整率和性别调整率，并通过多变量回归评估了时间段与PCCRC风险之间的独立关联PCCRC，近端PCCRC和远端PCCRC。

结果

在研究期间，特别是在较年轻的年龄组和非医院环境中，结肠镜检查量显着增加。在为期15年的研究期内，符合条件的1,093,658名患者中，PCCRC率保持稳定在8％左右。将2006年至2010年与1996年至2001年相比较，PCCRC，远端PCCRC和近端PCCRC的调整后赔率分别为1.14（95％置信区间[CI]，1.0-1.31），1.11（95％CI，0.91-1.34） ）和1.14（95％CI，0.94-1.38）。协变量调整后，根据内镜医师的专业或机构设置，PCCRC风险的时间趋势没有差异。

结论

随着时间的推移，安大略省的PCCRC率一直保持较高水平。需要采取广泛的措施来提高结肠镜检查的质量。