Systematic Review and Meta-analysis: The Three-year Post-colonoscopy Colorectal Cancer Rate as per the World Endoscopy Organization Methodology
Rawen Kader, Andreas V. Hadjinicolaou, Nicholas Burr, Paul Bassett, Omer F. Ahmad, Lasse Pedersen, Manish Chand, Roland Valori, Danail Stoyanov, Laurence Lovat
Abstract
BACKGROUND & AIMS: In 2018, the World Endoscopy Organization (WEO) introduced standardized methods for calculating post-colonoscopy colorectal cancer-3yr rates (PCCRC-3yr). This systematic review aimed to calculate the global PCCRC-3yr according to the WEO methodology, its change over time, and to measure the association between risk factors and PCCRC occurrences. METHODS: We searched 5 databases from inception until January 2024 for PCCRC-3yr studies that strictly adhered to the WEO methodology. The overall pooled PCCRC-3yr was calculated. For risk factors and time-trend analyses, the pooled PCCRC-3yr and odds ratios (ORs) of subgroups were compared. RESULTS: Several studies failed to adhere to the WEO methodology. Eight studies from 4 Western European and 2 Northern American countries were included, totalling 220,106 detected-colorectal cancers (CRCs) and 18,148 PCCRCs between 2002 and 2017. The pooled Western World PCCRC-3yr was 7.5% (95% confidence interval [CI], 6.4%-8.7%). The PCCRC-3yr significantly (P < .05) decreased from 7.9% (95% CI, 6.6%-9.4%) in 2006 to 6.7% (95% CI, 6.1%-7.3%) in 2012 (OR, 0.79; 95% CI, 0.72-0.87). There were significantly higher rates for people with inflammatory bowel disease (PCCRC-3yr, 29.3%; OR, 6.17; 95% CI, 4.73-8.06), prior CRC (PCCRC-3yr, 29.8%; OR, 3.03; 95% CI, 1.34-4.72), proximal CRC (PCCRC-3yr, 8.6%; OR, 1.51; 95% CI, 1.41-1.61), diverticular disease (PCCRC 3-yr, 11.6%; OR, 1.74; 95% CI, 1.37-2.10), and female sex (PCCRC-3yr, 7.9%; OR, 1.15; 95% CI, 1.11-1.20). CONCLUSION: According to the WEO methodology, the Western World PCCRC-3yr was 7.5%. Reassuringly, this has decreased over time, but further work is required to identify the reasons for PCCRCs, especially in higher-risk groups. We devised a WEO methodology checklist to increase its adoption and standardise the categorization of patients in future PCCRC-3yr studies.