Colonoscopy Quality Appears To Be Good in U.S. Veterans Administration Hospitals
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Colonoscopy Quality Appears To Be Good in U.S. Veterans Administration Hospitals

Douglas K. Rex, MD, MASGE, reviewing Kahi CJ, et al. JAMA Netw Open 2023 Apr.

In a study of 29,877 patients with colorectal cancer (CRC) in the U.S. Veterans Affairs (VA) health care system, the rate of postcolonoscopy colorectal cancer (PCCRC), defined as CRC diagnosed 6 to 36 months after a colonoscopy, was 6%. PCCRC was more likely when colonoscopy was performed outside the VA system (odds ratio [OR], 2.58) and less likely when performed by a gastroenterologist (OR, 0.48). PCCRC was more likely to be a right-sided colon cancer (OR, 2.01).

Patients with PCCRC were also more likely to present with bowel obstruction (OR, 1.64) or peritonitis (OR, 1.96), but all-cause mortality and cancer-specific mortality were nearly identical for PCCRC and colonoscopy-detected cancers.

Douglas K. Rex, MD, FASGE

COMMENT

Those outside the VA system sometimes have the impression that the quality of health care within the VA system is lower. However, the VA system operates a national quality control program for colonoscopy, and these data suggest that average colonoscopy quality within the VA system is actually better than outside the VA system.

Previous studies have produced a wide range of results about mortality associated with PCCRCs versus colonoscopy-detected cancers. The lack of a difference in mortality observed in this study most likely reflects that at the time of colonoscopy, PCCRC was missed because it was, on average, a small lesion relative to the average size of colonoscopy-detected cancers. Certainly, these data will not prevent the argument that cancer stage progressed between when a colonoscopy was negative for cancer and when PCCRC was ultimately diagnosed if the delay becomes the basis of a medical-legal case.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Kahi CJ, Myers LJ, Monahan PO, Barker BC, Stump TE, Imperiale TF. Mortality after postcolonoscopy colorectal cancer in the Veterans Affairs health care system. JAMA Netw Open 2023;6:e236693. (https://doi.org/10.1001%2Fjamanetworkopen.2023.6693)

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