TPW 2.08 Post-Colonoscopy Colorectal Cancer (PCCRC): Two-Year Audit Using the WEO Framework to Target Preventable Harm
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ID: 323971
2026
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Abstract
Abstract Aims Post-colonoscopy colorectal cancer (PCCRC) is a key quality marker reflecting missed lesions, incomplete therapy, or pathway delays. We audited PCCRC rates across two annual cohorts and applied the World Endoscopy Organization (WEO) framework to identify avoidable factors and improvement actions. Methods All colorectal cancers diagnosed between March 2023 and March 2025 were retrospectively reviewed. Cases preceded by lower GI-endoscopy within 36 months were classified as PCCRC using WEO criteria. Index endoscopy records were assessed for bowel preparation, lesion recognition, completeness, resection planning, coding, and time to definitive-therapy. Results Two PCCRC cases were identified across two cycles with low rates. Cycle 1 (03/2023–03/2024) recorded one PCCRC (0.6%), WEO Category C (detected but not resected), following poor bowel-preparation and delayed-definitive management. Learning themes included missed appointments, missed surveillance, cancers after flexible sigmoidoscopy, colonoscopy >3 years prior, and cancers diagnosed within 6 months. Improvements strengthened bowel prep/rebooking, surveillance tracking, and pathway awareness. Cycle 2 (03/2024–03/2025) recorded one PCCRC (0.7%) in an 81-year-old male with distal sigmoid cancer diagnosed 28 months after an index colonoscopy reporting small-benign-polyps and diverticulosis; further learning points related to investigation choice and referral delays. Conclusions The incidence of PCCRC at DGH remains below the threshold of 5%, suggested by JAG. Contributing factors included structured follow-up for patients ensuring optimal surveillance in tune with ACPGBI guidelines, improved awareness of PCCRC, enhanced techniques such as double walk on the right colon with white light and Narrow Band Imaging, standardised withdrawal times and regular emphasis on Key performance indicators.
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| Authors | Zain Ahmed Khan, Shashikanth Vijayaraghavalu, Sithdharthan Ravikumar, Namrata Aravindan, Stephen Loke, Bala Piramanayagam, Aravindan Narayanan |
| Journal | the british journal of surgery |
| Year | 2026 |
| DOI |
10.1093/bjs/znag087.307
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| URL | |
| Keywords | Keywords not found |
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