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Abstract:
BACKGROUND & AIMS:Postcolonoscopy colorectal cancer (PCCRC) is CRC diagnosed after a colonoscopy in which no cancer was found. A consensus article from the World Endoscopy Organization (WEO) proposed an approach for investigating and categorizing PCCRCs detected within 4 years of a colonoscopy. We aimed to identify cases of PCCRC and the factors that cause them, test the WEO system of categorization, quantify the proportion of avoidable PCCRCs, and propose a target rate for PCCRCs detected within 3 years of a colonoscopy that did not detect CRC. METHODS:We performed a retrospective analysis of 107 PCCRCs identified at a single medical center in England from January 1, 2010, through December 31, 2017 using coding and endoscopy data. For each case, we reviewed clinical, pathology, radiology, and endoscopy findings. Using the WEO recommendations, we performed a root-cause analysis of each case, categorizing lesions as follows: possible missed lesion, prior examination adequate; possible missed lesion, prior examination inadequate; detected lesion, not resected; or likely incomplete resection of previously identified lesion. We determined whether PCCRCs could be attributed to the colonoscopist for technical or decision-making reasons, and whether the PCCRC was avoidable or unavoidable, based on the WEO categorization and size of tumor. The endoscopy reporting system provided performance data for individual endoscopists. RESULTS:Of the PCCRCs identified, 43% were in high-risk patients (those with inflammatory bowel disease, previous CRC, previous multiple large polyps, or hereditary cancer syndromes) and 66% were located distal to the hepatic flexure. There was no correlation between postcolonoscopy colorectal tumor size and time to diagnosis after index colonoscopy. Bowel preparation was poor in 19% of index colonoscopies, and only 36% of complete colonoscopies had adequate photodocumentation of completion. Development of 73% of PCCRCs was determined to be affected by technical endoscopic factors, 17% of PCCRCs by administrative factors (follow-up procedures delayed/not booked by administrative staff), and 27% of PCCRCs by decision-making factors. Twenty-seven percent of PCCRCs were categorized as possible missed lesion, prior examination adequate; 58% as possible missed lesion, prior examination inadequate; 8% as detected lesion, not resected; and 7% as incomplete resection of previously observed lesion; 89% were deemed to be avoidable. CONCLUSIONS:In a retrospective analysis of PCCRCs, using the WEO system of categorization, we found 43% to occur in high-risk patients; this might be reduced with more vigilant surveillance. Measures are needed to reduce technical, decision-making, and administrative factors. We found that 89% of PCCRCs may be avoidable. If half of avoidable PCCRCs could be prevented, the target rate of 2% for the PCCRC-3y (cancer diagnosed between 6 and 36 months after index colonoscopy) benchmark would be achievable.
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最新影响因子:33.883 | 期刊ISSN:0016-5085 | CiteScore:6.95 |
出版周期:Monthly | 是否OA:YES | 出版年份:1943 |
自引率:3.70% | 研究方向:医学-胃肠肝病学 |
出版地区:UNITED STATES |
SCI期刊coverage:Science Citation Index Expanded(科学引文索引扩展)
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Gastroenterology is the most prominent journal in the field of gastrointestinal disease. As the official journal of the American Gastroenterological Association, Gastroenterology delivers up-to-date, authoritative, clinically oriented coverage of all areas in gastroenterology. Regular features include articles by leading authorities, reports on the latest treatments for diseases, and an exclusive correspondence section. Gastroenterology is organized into the following sections to make material easy to find: Alimentary Tract; Liver, Pancreas and Biliary Tract; Case Reports; Special Reports and Reviews; and a section on Clinical Challenges which presents more in-depth information on how a diagnosis is reached. An additional feature is the Image of the Month.
胃肠病学是胃肠疾病领域最著名的期刊。作为美国胃肠病学协会的官方杂志,胃肠病学提供最新的,权威的,以临床为导向的胃肠病学的所有领域的报道。定期的特写包括由权威机构撰写的文章,关于疾病的最新治疗方法的报道,以及一个独家的通讯栏目。胃肠病学分为以下几个部分,使材料容易找到:消化道;肝脏、胰腺和胆道;病例报告;特别报告和审查;还有一个关于临床挑战的章节,提供了关于如何做出诊断的更深入的信息。另外一个特性是该月的图像。
大类(学科) | 小类(学科) | 学科排名 |
医学 |
GASTROENTEROLOGY & HEPATOLOGY (胃肠肝病学) 1区 |
1/80 |
年度总发文量 | 年度论文发表量 | 年度综述发表量 |
278 | 251 | 27 |
引文计数(2018)
文献(2015-2017)
13021次引用
1874篇文献
序号 | 类别 | 排名 | 百分位 |
1 |
大类(学科):Medicine
小类(学科):Hepatology
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#0/59
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2 |
大类(学科):Medicine
小类(学科):Gastroenterology
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#2/128
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研究方向:淋巴瘤
接受率: 一般容易(75%命中)
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研究方向:医药科学 消化系统 肝胆胰免疫及相关疾病
审稿时间: 1个月内
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研究方向:消化病 胃肠道
接受率: 比较困难(25%命中)
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研究方向:胰腺癌
审稿时间: 2个月内 接受率: 比较困难(25%命中)
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研究方向:消化病 胃肠道
接受率: 比较困难(25%命中)
影响因子:1.242
ISSN:1459-6067
研究方向:农林科学-农业综合
影响因子:5.895
ISSN:0021-8561
研究方向:农林科学-农业综合
影响因子:1.125
ISSN:0791-6833
研究方向:农林科学-农业综合
影响因子:1.031
ISSN:2079-052X
研究方向:AGRONOMYFOOD SCIENCE & TECHNOLOGY&nb-FOOD SCIENCE
影响因子:4.225
ISSN:0022-0302
研究方向:农林科学-奶制品与动物科学
影响因子:2.027
ISSN:0022-0299
研究方向:农林科学-奶制品与动物科学
影响因子:3
ISSN:2494-1271
研究方向:-
影响因子:3.498
ISSN:1936-9751
研究方向:农林科学-食品科技
影响因子:6.738
ISSN:1866-7910
研究方向:FOOD SCIENCE & TECHNOLOGY-
发表一篇学和医学成像类SCI论文
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