01 September 2021 (Last updated 1 Nov 2021)

Rollout of a National Audit of Post-Colonoscopy Colorectal Cancers (PCCRCs) in England will begin in September 2021.

In the last 20 years the colonoscopy service in England has made huge strides but there is always room for improvement. The PCCRC audit will identify ways to fine-tune the service to achieve excellence.

Preliminary data from 10 trusts indicates that PCCRCs are not just about adenoma detection rates. Quality of colonoscopy is important, but there are other avoidable factors that lead to PCCRCs, and some unavoidable ones. The intention of the audit is to find areas in need of improvement and act on them, NOT to find fault with individuals.

More information about the National PCCRC audit

The audit follows the recommendation made by the World Endoscopy Organisation (WEO) to review PCCRCs occurring within 48 months of a colonoscopy that did not show cancer [1]. For practical purposes a 6-48 month window has been chosen. More than 1,500 cancers diagnosed each year have been preceded by a colonoscopy that did not show cancer in this window. A recent British study suggests up to 80% of these are potentially avoidable [2]. The ultimate goal of the audit is to reduce PCCRCs following colonoscopies performed from 2022 onwards by 50%.

PCCRC rates are proposed as a key quality indicator of colonoscopy by the BSG, and the JAG requires units to audit them to maintain accreditation. It has, however, been very difficult for services to identify cases reliably, not least because the cancer is often diagnosed in a different trust (up to 20% of PCCRCs in some urban areas).

To help services identify and audit PCCRCs a National reporting system has been developed. PCCRCs are identified using central databases and the trust where the colonoscopy was performed notified of cases via a secure portal. The portal has an audit tool designed to help determine the most plausible explanation for the PCCRC as defined by the WEO [1]. The BSG, the JAG, ACPGBI and NHSE support this audit. The JAG has recently reduced the burden of audit for accreditation to allow time to review PCCRCs.

In the initial phase up to 25 PCCRCs will be uploaded for each trust. We anticipate a further upload of PCCRCs three times a year as new cases are captured with refresh of national database linkages.

Endoscopy team leaders will be encouraged to discuss each case, together with the most plausible explanation, with individual endoscopists and present an overview of lessons learned anonymously to the wider team. It is extremely important to stress that the sample size of cases will be far too small to draw conclusions about the competence of individual endoscopists. Having said this, judging by the published audit [2], there will be important lessons to learn for individual endoscopists and referrers, and the service as a whole. The overall intention is to find areas in need of improvement and act on them, NOT to find fault.
 

References

1         Rutter MD, Beintaris I, Valori R, et al. World Endoscopy Organization Consensus Statements on Post-Colonoscopy and Post-Imaging Colorectal Cancer. Gastroenterology 2018;155:909-925.e3. doi:10.1053/j.gastro.2018.05.038

2         Anderson R, Burr NE, Valori R. Causes of Post-colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis. Gastroenterology Published Online First: January 2020. doi:10.1053/j.gastro.2019.12.031          

National PCCRC audit - Frequently asked questions

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