Cancer Res Treat.  2024 Oct;56(4):1164-1170. 10.4143/crt.2024.009.

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

• Kim DJ
• Yoon NH
• Jun JK
• Suh M
• Lee S
• Kim S
• Kim JE
• Lee H

• KMID: 2560250
• DOI: http://doi.org/10.4143/crt.2024.009

Abstract

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.

Keyword

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

Figure

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  Fig. 1. Flow diagram of participant recruitment from the nationwide screening program. CRC, colorectal cancer; iCRC, interval colorectal cancer; FIT, fecal immunochemical test; KNCSP, Korean National Cancer Screening Program.

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  Fig. 2. Risk of interval colorectal cancer by endoscopist volume according to the type of screening facility and screening year (ref=V5). Relative risk adjusted for the type of medical institution and the screening year considered in the study.

Reference

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