Systematic Review and Meta-analysis: The Three-year Post-colonoscopy Colorectal Cancer Rate as per the World Endoscopy Organization Methodology

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.

Citation

Kader, R., Hadjinicolaou, A. V., Burr, N. E., Bassett, P., Ahmad, O. F., Pedersen, L., Chand, M., Valori, R., Stoyanov, D., & Lovat, L. B. (2025). Systematic Review and Meta-analysis: The Three-year Post-colonoscopy Colorectal Cancer Rate as per the World Endoscopy Organization Methodology. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 23(4), 519–530. https://doi.org/10.1016/j.cgh.2024.07.039

DOI

10.1016/j.cgh.2024.07.039

URI

https://hdl.handle.net/20.500.14709/397

Usage rights

CC BY 4.0

License

https://creativecommons.org/licenses/by/4.0/