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Quality indicators for colonoscopy should be designed to render the outcomes of healthcare services measurable and transparent for both patients and physicians. For example, as the goal of colonoscopy is to prevent and detect colorectal cancer (CRC), improved quality should minimise the postcolonoscopy colorectal cancer (PCCRC) rate. In fact, most other indicators of procedural quality, such as adenoma detection rate and caecal intubation rate, owe their validation to a correlation with PCCRC rate. In an ideal world, rigorous monitoring of PCCRC rates can be used for benchmarking at multiple levels (regional, national, international) and would be a key driver of colonoscopy quality improvement within and outside screening programmes. It is therefore crucial to use a common language and common methodology when measuring, monitoring and reporting PCCRC.
The process of benchmarking is neither quick nor simple. It starts with the implementation of a uniform terminology for a PCCRC. The term ‘PCCRC’ refers to colonoscopy in general, performed for screening, surveillance or symptoms, whereas the term ‘interval CRC’ refers to screening and colonoscopy surveillance, when a follow-up time interval is specified (intention-to-screen).1 The next key issue is what and how to monitor for calculating PCCRC rates. Several caveats should be recalled, foremost of which are the lack of complete clinical information, hurdles in crosslinking a cancer registry to colonoscopy databases and ambiguity on how to calculate rates. Such factors hinder meaningful interpretation of PCCRC rates and defining of quality standards, as shown by Morris et …