Association between Endoscopist Volume and Interval Cancers after Colonoscopy: Results from the National Colorectal Cancer Screening Program in Korea.

Publisher: Korean Cancer Association Country of Publication: Korea (South) NLM ID: 101155137 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2005-9256 (Electronic) Linking ISSN: 15982998 NLM ISO Abbreviation: Cancer Res Treat Subsets: MEDLINE

Original Publication: Seoul, Korea : Korean Cancer Association,

Colonoscopy*/statistics & numerical data ; Colorectal Neoplasms*/diagnosis ; Colorectal Neoplasms*/epidemiology ; Early Detection of Cancer*/methods; Humans ; Female ; Male ; Republic of Korea/epidemiology ; Middle Aged ; Aged ; Mass Screening/methods

Purpose: The rate of interval colorectal cancer (iCRC) is now accepted as a key performance indicator of organized colorectal cancer (CRC) screening programs. We aimed to examine the association between endoscopist volumes and the rate of iCRC among individuals with a positive fecal immunochemical test (FIT) within a nationwide population-based CRC screening program.
Materials and Methods: Individuals aged ≥ 50 years who underwent colonoscopy after a positive FIT from January 1, 2019 until December 31, 2020 in the Korean National Cancer Screening Program (KNCSP) were enrolled. We converted the data into per-endoscopist screening results, calculated the iCRC rates per endoscopist, and compared them to the previous year's annual volume that was divided into five groups (V1, 1-9; V2, 10-29; V3, 30-59; V4, 60-119; V5, ≥ 120).
Results: A total of 10,412 endoscopists performed 216,907 colonoscopies. Overall, the average rate of iCRC per endoscopist was 8.46 per 1,000 examinations. Compared with the group with the highest volume (V5 group), the rate of iCRC was 2.21 times higher in the V1 group. Similar trends were observed in the other groups (V2: relative risks [RR], 2.15; 95% confidence interval [CI], 1.57 to 2.94; V3: RR, 1.56; 95% CI, 1.15 to 2.13; V4: RR, 1.18; 95% CI, 0.83 to 1.67).
Conclusion: The findings emphasize that endoscopists with lower procedure volumes have higher risks of interval cancer being missed or undetected. To maximize the preventative impact of colonoscopy for CRC, this issue should be addressed by monitoring endoscopist volumes and variations in performances.

Cancer Res Treat. 2018 Jan;50(1):50-59. (PMID: 28231692)
Cancer. 2012 Sep 15;118(18):4404-11. (PMID: 22707430)
Curr Gastroenterol Rep. 2019 Jul 10;21(8):36. (PMID: 31289917)
PLoS One. 2013 Nov 08;8(11):e79292. (PMID: 24260189)
N Engl J Med. 2003 Nov 27;349(22):2117-27. (PMID: 14645640)
Endoscopy. 2012 Sep;44 Suppl 3:SE88-105. (PMID: 23012124)
Gut Liver. 2022 Nov 15;16(6):930-941. (PMID: 35466090)
Clin Gastroenterol Hepatol. 2020 Sep;18(10):2192-2208.e12. (PMID: 32240836)
J Clin Gastroenterol. 2015 Jul;49(6):483-90. (PMID: 25090450)
Am J Gastroenterol. 2019 Aug;114(8):1315-1321. (PMID: 30848731)
Gastrointest Endosc. 2018 Oct;88(4):705-711.e1. (PMID: 29803767)
Am J Gastroenterol. 2010 Dec;105(12):2588-96. (PMID: 20877348)
Nat Rev Clin Oncol. 2013 Mar;10(3):130-42. (PMID: 23381005)
Am J Gastroenterol. 2015 Dec;110(12):1657-64; quiz 1665. (PMID: 26553207)
Clin Endosc. 2018 May;51(3):239-252. (PMID: 29874905)
BMC Med Res Methodol. 2014 Jun 26;14:82. (PMID: 24965498)
Endoscopy. 2016 Mar;48(3):241-7. (PMID: 26845473)
Can J Gastroenterol Hepatol. 2014 May;28(5):251-74. (PMID: 24839621)
Cancer Res Treat. 2023 Jul;55(3):910-917. (PMID: 36915246)
Intest Res. 2014 Apr;12(2):110-6. (PMID: 25349577)
Sci Rep. 2022 Jul 5;12(1):11380. (PMID: 35790880)
Gut. 2012 Nov;61(11):1576-82. (PMID: 22200840)
Clin Endosc. 2018 Jan;51(1):50-55. (PMID: 29397649)
Gut. 2015 Aug;64(8):1257-67. (PMID: 25193802)
Ann Intern Med. 2022 Oct;175(10):1366-1373. (PMID: 36162114)
Cancer. 2012 Jun 15;118(12):3044-52. (PMID: 21989586)
Nat Rev Gastroenterol Hepatol. 2012 Sep;9(9):550-4. (PMID: 22907162)
Lancet Oncol. 2005 Nov;6(11):871-6. (PMID: 16257795)
N Engl J Med. 2002 Apr 11;346(15):1128-37. (PMID: 11948273)
Gut. 2017 Feb;66(2):293-300. (PMID: 26515543)
N Engl J Med. 2010 May 13;362(19):1795-803. (PMID: 20463339)
J Am Coll Surg. 2017 Nov;225(5):666-675.e2. (PMID: 28838870)

National Cancer Center; HA21C0225 Ministry of Health and Welfare

Keywords: Cancer screening; Colonoscopy; Colorectal neoplasms; Endoscopist volume; Interval cancers; Quality management

Date Created: 20240419 Date Completed: 20241015 Latest Revision: 20241023

20241023

PMC11491247

10.4143/crt.2024.009

38637965