Clinical features of post-colonoscopy colorectal cancer and real-world multi-scale correlation analysis

doi:10.4240/wjgs.v18.i1.112954

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 18, Issue 1

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (95)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-1) series, Tables (1-4) series.

Item

Count

PDF

HTML

Figures (1-1)

Tables (1-4)

Sum=37

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

Sum=73

Jan 27, 2026 (publication date) through Jan 28, 2026

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Surg. Jan 27, 2026; 18(1): 112954
Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.112954

Clinical features of post-colonoscopy colorectal cancer and real-world multi-scale correlation analysis

Yuan Li, Chu-Yan Wang, Ya-Xin Li, Zhu-Jun Wu, Lin-Jie Guo

Yuan Li, Chu-Yan Wang, Ya-Xin Li, Zhu-Jun Wu, Lin-Jie Guo, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China

Co-first authors: Yuan Li and Chu-Yan Wang.

Author contributions: Li Y and Guo LJ participated in the literature search and study design; Li Y, Wang CY, and Guo LJ participated in the data analysis, data interpretation, writing, and critical revision; Li Y and Wang CY contributed equally to this article, they are the co-first authors of this manuscript; Li Y, Wang CY, Guo LJ, Li YX, and Wu ZJ participated in data collection; Li YX and Wu ZJ reviewed all the medical imaging, and prepared all the figures; and all authors reviewed the manuscript.

Institutional review board statement: This study was approved by the Medical Ethics Committee of West China Hospital, Sichuan University, No. 2025 (419).

Informed consent statement: Given the retrospective nature of the study, the Institutional Review Board granted a waiver for the requirement of informed consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Lin-Jie Guo, MD, Associate Professor, Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, Sichuan Province, China. guolj08@163.com

Received: August 15, 2025
Revised: September 12, 2025
Accepted: December 2, 2025
Published online: January 27, 2026
Processing time: 159 Days and 24 Hours

Abstract

BACKGROUND

Post-colonoscopy colorectal cancer (PCCRC) remains an important issue in endoscopic examination. This study investigates the clinical features of PCCRC and possible correlation factors.

AIM

To explore clinical features of PCCRC and correlation factors.

METHODS

A retrospective cohort analysis enrolled patients diagnosed with colorectal cancer (CRC) via colonoscopy at West China Hospital, Sichuan University, between January 1, 2022, and December 30, 2024. Demographic data, tumor characteristics, endoscopic findings, and miss records were extracted from electronic medical records and telephone follow-ups. An exploratory analysis was performed to identify causes of missed diagnosis during endoscopy.

RESULTS

Among 5411 colonoscopies in 2047 CRC patients, 66 prior examinations (27 colonoscopies in 17 non-PCCRC patients; 39 colonoscopies in 25 PCCRC patients) failed to establish diagnosis. The overall miss rate was 1.2%, with a PCCRC rate of 0.7%. Compared to the non-PCCRC group, advanced age was significantly associated with PCCRC (P = 0.006). The most common location that occurred PCCRC was sigmoid colon. PCCRC cases had higher rate of prior CRC surgery (41.0%). For endoscopists, PCCRC cases with CRC surgery increased the risk of judgement error. Insertion time demonstrated a positive correlation with missed diagnosis risk, whereas withdrawal time exhibited a negative correlation.

CONCLUSION

The incidence of PCCRC remains significant. Beyond tumor characteristics, endoscopist proficiency and procedural factors critically impact detection accuracy.

Keywords: Post-colonoscopy colorectal cancer; Gastrointestinal endoscopy; Colorectal neoplasms; Colonoscopy quality; Endoscopist

Core Tip: The incidence of post-colonoscopy colorectal cancer (CRC) remains significant. Patients with advanced age or prior CRC surgical history are associated with an elevated risk of post-colonoscopy CRC and may warrant shorter surveillance intervals for follow-up colonoscopy. The proficiency of the endoscopist can also influence the incidence of post-colonoscopy CRC. Enhancing technical proficiency among endoscopists and prolonging withdrawal time during colonoscopy may reduce post-colonoscopy CRC risk.