array:22 [ "pii" => "S021057052300345X" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2023.05.014" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "2089" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Gastroenterol Hepatol. 2024;47:319-26" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0210570523003461" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2023.05.015" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "2090" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Gastroenterol Hepatol. 2024;47:327-36" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Impact of biliary stents in the performance of the EUS-guided tissue acquisition: A systematic review and meta-analysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "327" "paginaFinal" => "336" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto de los stents biliares en el rendimiento de la adquisición de biopsias guiadas por ecoendoscopia: una revisión sistemática y metanálisis" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 799 "Ancho" => 2925 "Tamanyo" => 259050 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Proportion of technical success in the group with stent.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Edson Guzmán-Calderón, Alfonso Chacaltana, Carlos Díaz-Arocutipa, Ramiro Díaz, Ronald Arcana, José Ramón Aparicio" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Edson" "apellidos" => "Guzmán-Calderón" ] 1 => array:2 [ "nombre" => "Alfonso" "apellidos" => "Chacaltana" ] 2 => array:2 [ "nombre" => "Carlos" "apellidos" => "Díaz-Arocutipa" ] 3 => array:2 [ "nombre" => "Ramiro" "apellidos" => "Díaz" ] 4 => array:2 [ "nombre" => "Ronald" "apellidos" => "Arcana" ] 5 => array:2 [ "nombre" => "José Ramón" "apellidos" => "Aparicio" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570523003461?idApp=UINPBA00004N" "url" => "/02105705/0000004700000004/v2_202406091228/S0210570523003461/v2_202406091228/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Postcolonoscopy colorectal cancer: Prevalence, categorization and root-cause analysis based on the World Endoscopic Organization system" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "319" "paginaFinal" => "326" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Antonio Z. Gimeno-García, Anjara Hernández-Pérez, Federica Benítez, Noemi Segura, David Nicolás-Pérez, Enrique Quintero, Noemi Hernández-Álvarez, Isabel Betancor, Eduardo Salido, Manuel Hernández-Guerra" "autores" => array:10 [ 0 => array:4 [ "nombre" => "Antonio Z." "apellidos" => "Gimeno-García" "email" => array:1 [ 0 => "antozeben@gmail.com" ] "referencia" => array:5 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] 4 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Anjara" "apellidos" => "Hernández-Pérez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 2 => array:3 [ "nombre" => "Federica" "apellidos" => "Benítez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Noemi" "apellidos" => "Segura" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "David" "apellidos" => "Nicolás-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Enrique" "apellidos" => "Quintero" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "Noemi" "apellidos" => "Hernández-Álvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Isabel" "apellidos" => "Betancor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 8 => array:3 [ "nombre" => "Eduardo" "apellidos" => "Salido" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 9 => array:3 [ "nombre" => "Manuel" "apellidos" => "Hernández-Guerra" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Gastroenterología, Hospital Universitario de Canarias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de La Laguna, Tenerife, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario de Canarias, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cáncer colorrectal poscolonoscopia. Prevalencia, categorización y análisis de las causas subyacentes basado en las recomendaciones de la Organización Mundial de Endoscopia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 900 "Ancho" => 3341 "Tamanyo" => 167418 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Categorization of the postcolonoscopy colorectal cancer based on the World Endoscopy Organization consensus statements.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Postcolonoscopy colorectal cancer (PCCRC) is an important quality parameter in clinical practice.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1,2</span></a> PCCRC has been reported to account for 3.6–9.3% of all diagnosed colorectal cancers (CRCs), although the definitions used for PCCRC vary across studies.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In 2018, the World Endoscopy Organization (WEO) defined PCCRC as a case of CRC that appears after a colonoscopy in which no CRC was detected. For benchmarking and to allow comparisons between centers, an interval of 3 years from the last colonoscopy and the diagnosis has been suggested.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> Although various factors may be involved in the finding of a PCCRC, missing a significant lesion is a major issue. In a recent study carried out in the UK, 58% of PCCRCs were attributed to quality deficiencies of the endoscopic procedure.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> Other potential explanations, such as fast-growing lesions or tumor seeding via the colonoscope working channel, have also been proposed by some authors.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> In addition, performing the procedure at intervals different from recommended intervals can also lead to the diagnosis of PCCRC.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The WEO recommends the assessment of the PCCRC rate by endoscopy units as well as a review of the potential causes (root-cause analysis) in each particular case.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The WEO differentiates between interval and noninterval PCCRCs. An interval PCCRC is the one that is detected before the follow-up surveillance or screening colonoscopy.</p><p id="par0025" class="elsevierStylePara elsevierViewall">This categorization of PCCRC and the implementation of the root-cause analysis are of great importance since it allows us to identify the existing gaps in endoscopists and endoscopy units to be able to design improvement strategies. There are currently few studies evaluating the potential causes of PCCRC, and none have been carried out in Spain.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Thus, the main outcome of the present study was to evaluate the prevalence of PCCRC in a cohort of patients according to the definition of the WEO. We assessed the categorization of PPCRC and the applicability of the WEO algorithm to attribute causality as secondary outcomes.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">This is an observational retrospective study carried out at the University Hospital of Canary Islands, a tertiary referral hospital that provides health care to approximately 400,000 inhabitants of the northern part of Tenerife Island. The endoscopy unit has an annual output of approximately 6000 outpatient colonoscopies, 3000 of which are performed during morning sessions. All patients diagnosed with colorectal adenocarcinoma from January 2018 to December 2019 were retrieved from the histological register of the Pathological Anatomy Department (including resected tumors as well as endoscopic biopsies). They were cross-referenced with our endoscopy database (Endobase, Olympus, Japan). Examinations have been carried out in our Endoscopy unit since 2008, and endoscopic reports were stored and available for consultation at the mentioned database. Colonoscopies were performed by 12 experienced endoscopists. The Ethics Committee approved the study protocol (CHUC_2021_115) in November 2021. All authors had access to the study data and reviewed and approved the final manuscript.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data collection</span><p id="par0040" class="elsevierStylePara elsevierViewall">Colonoscopy reports of the index colonoscopy as well as past colonoscopy reports, histological reports and clinical records were retrieved.</p><p id="par0045" class="elsevierStylePara elsevierViewall">A datasheet was used to collect information regarding the diagnosis of the PCCRC (index colonoscopy or surgery) and the quality metrics of the previous colonoscopy. The date of colonoscopy, age, sex, indication, quality parameters recorded in the previous colonoscopy report (cecal intubation, withdrawal time, cleansing quality according to the Boston Bowel Preparation Scale (BBPS)<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>) as well as photodocumentation of the cecum, rectal retroflexion and abnormalities were collected. Similarly, we assessed whether all the polyps were resected or not in the last examination, and the technique of resection included en bloc or piecemeal excision, as well as the characteristics of the polyps (morphology according Paris classification, size, histology and location).<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> In our unit, polyp size is usually measured with open forceps as previously described or by the pathological report when the lesion is resected en bloc.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> Histological analysis was performed according to the Vienna classification.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> For the purpose of the study, polyps were categorized as advanced lesions (defined as adenoma ≥1<span class="elsevierStyleHsp" style=""></span>cm, villous glandular pattern, or high-grade dysplasia; sessile serrated lesion ≥1<span class="elsevierStyleHsp" style=""></span>cm or with dysplasia and traditional serrated lesion) or nonadvanced lesions.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In our unit, an additional report with the recommended surveillance based on the endoscopy findings and histology is always sent to the referring doctor. This report is in accordance with the most recent ESGE (European Society of Gastrointestinal Endoscopy) guidelines for adenoma surveillance, and it is also stored in our endoscopy database.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> Additional information needed for root-cause analysis or categorization was reviewed from the institutional database if needed.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Root-cause analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Two expert endoscopists independently evaluated the most plausible cause according to the WEO criteria and based on the information in the datasheet. Agreement was assessed among the 2 raters. In case of any discrepancy, the final decision was made by consensus and served as the reference standard.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Cause-root analyses were limited to 4 years before the diagnostic colonoscopy, according to the WEO.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> If the previous colonoscopy was performed more than 4 years before the index colonoscopy, the CRC was considered “likely a new CRC”. If an advanced adenoma was detected in the same segment of the CRC, it would be considered the most plausible explanation either if it was resected without histological confirmation of complete resection (likely incomplete resection) or left in place. If there was no advanced neoplasia in the same segment, the report was reviewed regarding shortcomings in quality metrics such as the achievement of cecal intubation (mentioned in the report) and quality of bowel preparation following the Boston Bowel Preparation Scale (BBPS).<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> If cecal intubation was not achieved or bowel preparation was poor (BBPS<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>2 in one or more segments), the examination was deemed inadequate, and a missed lesion was suspected as the most plausible explanation of PCCRC. If the index colonoscopy met quality measures, the examination was deemed adequate, and missed lesions were suspected. A summary of the plausible explanations is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">PCCRC categorization</span><p id="par0065" class="elsevierStylePara elsevierViewall">An interval CRC was defined as a CRC diagnosed before the surveillance or screening colonoscopy according to the ESGE recommendations.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> A noninterval CRC was considered if it was diagnosed at or after the recommended screening or surveillance colonoscopy. A noninterval PCCRC was classified as type A (detected at the recommended screening or surveillance interval), type B (detected after the recommended screening or surveillance interval) and type C (no screening or surveillance interval was set)<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the case of noninterval PCCRC, we checked our endoscopic and institutional database if a follow-up colonoscopy was registered. If it was registered and there was no report, the patient did not undergo the examination, and the noninterval PCCRC was classified as Type B. If a follow-up colonoscopy was not registered, patients’ charts were reviewed to check if the patient refused to undergo a surveillance colonoscopy (PCCRC type B) or it was not requested (PCCRC type C).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Outcomes</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Primary outcome</span><p id="par0075" class="elsevierStylePara elsevierViewall">The primary outcome was the rate of PCCRC, defined as the number of PCCRCs/number of PCCRCs<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>CRC detected. For benchmarking, the 3-year PCCRC rate was calculated (PCCRC detected between 6 months and 36 months after the colonoscopy). We also calculated the 4-year PCCRC rate.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Secondary outcomes</span><p id="par0080" class="elsevierStylePara elsevierViewall">To infer the most plausible explanation for the development of the PCCRC based on the WEO recommendations, a 4-year interval between the previous colonoscopy and the diagnosis was considered. PPCRCs diagnosed beyond the 4-year interval were considered new-onset CRCs.</p><p id="par0085" class="elsevierStylePara elsevierViewall">PCCRCs were classified as interval and noninterval PCCRC, including noninterval Type A, Type B or Type C PCCRC.</p><p id="par0090" class="elsevierStylePara elsevierViewall">A PCCRC was considered not preventable in the following cases<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>: small CRCs estimating an annual growth<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm/year; follow-up colonoscopy in patients older than 80 years or with severe comorbidities<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">10,11</span></a>; the patient refuses or does not attend the surveillance colonoscopy.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0095" class="elsevierStylePara elsevierViewall">Numerical variables were presented by means and standard deviations and by medians and ranges. Categorical variables are expressed as percentages. The 3-year and 4-year PCCRC rates were calculated. PCCRC was classified as interval and noninterval CRC. For this purpose, the elapsed time between the previous colonoscopy and the diagnosis of PCCRC was considered.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Interobserver agreement in causality attribution and PCCRC categorization was measured by Cohen's kappa (<span class="elsevierStyleItalic">κ</span>).</p><p id="par0105" class="elsevierStylePara elsevierViewall">A sensitivity analysis for root-cause analysis was carried out considering (1) explorations with cecal/terminal ileum and rectal retroflexion (in case of rectal PCCRC) photodocumentation and withdrawal time ≥6<span class="elsevierStyleHsp" style=""></span>min; (2) inclusion of any polyp in the localization segment of the postcolonoscopy CRC; and (3) inclusion of any advanced adenomas in the neighboring segment of the PCCRC.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Data were analyzed with the Statistical Package for Social Sciences v. 25.0 (Armonk, NY: IBM Corp.).</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0115" class="elsevierStylePara elsevierViewall">A total of 14,228 colonoscopies were performed in 11,468 patients from 1 January 2018 to 31 December 2019. Overall, 562 CRCs were diagnosed during the study period. Patients derived from private centers for surgery (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>28) were excluded since past records could not be retrieved. Four patients with local recurrence of CRC were also excluded. Finally, from a total of 530 patients (age 69.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.1 years; 58.3% males), 33 patients were found to have PCCRC (age 75.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.5 years; 51.5% women). Colonoscopy indications and staging of the PCCRCs are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Characteristics of the PCCRCs are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The 3-year and 4-year PCCRC rates were 3.4% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18), 4.7% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>25), respectively.</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Root-cause analysis</span><p id="par0125" class="elsevierStylePara elsevierViewall">The agreement between the two observers in the root-cause analysis was fair (<span class="elsevierStyleItalic">k</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.958; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). There was disagreement in one single case. In this case, stage I rectal cancer was diagnosed, and an advanced adenoma located in the sigmoid colon was resected in the previous colonoscopy. The examination was not completed. The most plausible cause (“possible missed lesion, inadequate examination”) was reached by consensus.</p><p id="par0130" class="elsevierStylePara elsevierViewall">A total of 8 PCCRCs were diagnosed more than 4 years after the previous colonoscopy, and therefore, they were considered new-onset CRC. Of the 25 PCCRC patients diagnosed before 4 years, 6 patients (24%) had an advanced adenoma resected in the same segment of the subsequently diagnosed PCCRC, 5 patients (28%) had inadequate bowel preparation, and in 2 (8%), the examination was not completed because of technical issues. In the remaining cases, despite meeting quality standards, the lesion was not detected. The potential sources of PCCRC are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. As shown, “possible a missed lesion with an adequate examination” comprised more than half of the PCCRCs (52%).</p><p id="par0135" class="elsevierStylePara elsevierViewall">Photodocumentation of the cecum or terminal ileum was reported in 60% of the cases (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15), and rectal retroflexion was reported in 44% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11). Only 39.9% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13) of colonoscopy reports had proper photodocumentation. The withdrawal time was longer than 6<span class="elsevierStyleHsp" style=""></span>min in all cases. The sensitivity root-cause analysis considering proper photodocumentation, withdrawal time and nonadvanced adenoma location in the same place of the PCCRC is also shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. In this case, “possible missed lesion with an inadequate examination” was the prevailing cause.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In a total of 2 patients, an advanced adenoma was resected in the neighboring segment of the subsequent PCCRC. The sensitivity root-cause analysis is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Categorization of PCCRC</span><p id="par0145" class="elsevierStylePara elsevierViewall">The agreement between the two observers in the categorization of the PCCRC was fair (<span class="elsevierStyleItalic">k</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.76; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). There was disagreement in 5 cases. A total of 5 PCCRCs (15.2%) were categorized as interval PCCRCs, while 11 cases (33.3%) were categorized as noninterval type B PCCRCs and 17 cases (51.5%) as noninterval type C PCCRCs (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Potentially avoidable PCCRCs</span><p id="par0150" class="elsevierStylePara elsevierViewall">The majority of PCCRCs were considered avoidable (28/33, 84.8%). A total of 5 cases were not considered avoidable: 1 case because of its small size; in 2 patients, a surveillance colonoscopy was not requested after resection of 3 nonadvanced adenomas and 6 nonadvanced adenomas because of advanced age; in the other 2 patients, a second colonoscopy was requested because of inadequate bowel cleansing, but the patients did not attend the appointment.</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">PCCRC is the main outcome measure of quality in colonoscopy. The WEO recommended its periodical assessment in endoscopy units. Some organizations, such as the UK Joint Advisory Group, have implemented the PCCRC rate as a quality criterion for endoscopy units in the UK.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Most studies using the WEO recommendations have been carried out in the UK.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1,5</span></a> To our knowledge, this is the first study that assessed WEO quality recommendations for cause-root analysis and categorization of PCCRCs in Spain in a nonselected population.</p><p id="par0165" class="elsevierStylePara elsevierViewall">We found that the 3-year PCCRC rate was 3.4% and the 4-year PCCRC rate was 4.7%. Our cause-root analysis revealed that almost two-thirds of all PCCRCs (63.6%) and 84% excluding newly diagnosed PCCRCs were due to a possible missed lesion with either prior adequate or inadequate examination. Our 3-year PCCRC rate is in the lower range of the reported studies.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1,3,5,13</span></a> A recent systematic review reported a 3-year PCCRC rate between 3.4% and 10.4%.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> Recently, a study suggested that most of these lesions were avoidable and that the percentage of PCCRC should not exceed 3.6%.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> Our 3-year PCCRC rate seems to meet this suggested benchmark. Other studies also found that a possible missed lesion was the most plausible explanation of PCCRC. Beaton et al. included 48 PCCRCs detected in 2 years.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> A possible missed lesion explained 91% of PCCRCs, especially when the examination was adequate (66%). In another UK study that included 107 PCCRCs detected in 7 years, 85% were possible missed lesions but at the expense of inadequate examinations (58%).<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> Our findings are in line with the results of these studies, with the most plausible explanations being missed lesions that were either adequate or inadequate. It is worth stressing that approximately half of the 4-year PCCRC rate was possibly missed with adequate examination, suggesting that the WEO approach could be useful to detect gaps in colonoscopy quality and areas for improved action. These recommendations could be useful to develop tailored strategies to reduce PCCRC rates. In our case, actions such as increasing technical skills of the endoscopists and knowledge for the detection of subtle colonic lesions could be useful. The high interobserver agreement on the cause-root analysis (<span class="elsevierStyleItalic">k</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.958) validates the recommendations of the WEO, suggesting that the proposed approach is reproductible and easy to use. Our results are similar to those found by Beaton et al., where the cause-root analysis agreement between the observers was almost perfect (<span class="elsevierStyleItalic">k</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.94) and the PCCRC categorization was good (<span class="elsevierStyleItalic">k</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.67).<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Regarding the sensitivity analysis, it is known that endoscopist perception of the bowel segment is unreliable.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> When we included advanced neoplastic lesions located in the neighboring segment of the subsequent PCCRC, 2 additional patients shifted from “possibly missed lesion” to “incomplete resection” in the cause-root analysis. Although it represents a small change regarding the raw analysis, these results suggested that there is some room for improvement in the endoscopic report; for instance, it could be useful to include if the scope was straight or a loop was formed when the distance was calculated. Adequate photodocumentation is a quality metric and a surrogate marker of a careful examination. In this sense, only 39.9% of the patients had adequate photodocumentation in the endoscopic report, a rate similar to that reported in other studies.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1,5</span></a> In the sensitivity analysis, 4 patients previously considered “missed lesion, adequate examination” shifted to “missed lesion, inadequate examination”. These changes are remarkable, since, despite being reported as complete colonoscopies, in two cases, the PCCRCs were located in the cecum and in one case in the rectum, and photodocumentation of these sites was missing. Finally, a third sensitivity analysis considering nonadvanced lesions as a potential source of PCCRCs was carried out. Although this is unlikely, it cannot be completely ruled out.</p><p id="par0175" class="elsevierStylePara elsevierViewall">Beaton et al. found that noninterval PCCRC comprised 85% of all PCCRC, mostly at the expense of type B (31.3%) and C (41.7%) PCCRC. Our study supports these results since 78.8% of the PCCRCs were nonintervals with a predominance of Type C PCCRCs. Type B PCCRC could be justified by cancelation of the endoscopic appointments by the patients, difficulties scheduling new appointments because of long waiting lists or even administrative mistakes, as other authors have pointed out.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> Although, we have access to check whether the colonoscopy was scheduled and whether colonoscopy was or was not performed, given the retrospective nature of our study the specific explanation in some cases is unknown (i.e., administrative mistakes, delayed appointment because of long waiting lists, etc.).</p><p id="par0180" class="elsevierStylePara elsevierViewall">In some cases of noninterval type C PCCRCs, the exact justification for not scheduling a follow-up or surveillance colonoscopy was not stated. However, all cases were supported by the recommended guidelines. In these patients, there was either no need for surveillance based on the findings of the last colonoscopy or the comorbidities precluded the recommendation of a surveillance colonoscopy. Beaton et al. attributed the high rate of noninterval type C PCCRCs to the high volume of colonoscopies requested for symptoms in which no surveillance recommendation was the rule.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> This was not the case in our study, in which most PCCRC were found in screening colonoscopies after a positive fecal occult blood test or postpolypectomy surveillance. In addition, regardless of the indication of the examination, we always complete a report for the referring physician, including the surveillance recommendations, depending on the findings. A recent retrospective study, carried out in a Spanish province (Basque country), assessed the PPCRC detected from 2009 to 2017 in patients participating in the Basque country screening program.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Unlike the present study, since surveillance recommendations were always performed, there were no cases of type C PCCRC. A total of 50 cases were classified as interval PPCRC, 61 were classified as type A PCCRC and 17 were classified as type B PCCRC. These results may reflect the distribution in the context of an organized screening program. A root-cause analysis was not carried out.</p><p id="par0185" class="elsevierStylePara elsevierViewall">In any case, interval and noninterval categorization may change over time with the release of updated surveillance guidelines. Indeed, the recommendations taken as a reference in this study are not the same as the most updated guideline.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Recently, it has been suggested that the highest incidence of PCCRC occurs in cases of high-risk population.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> However, in our study, none of the patients with a known hereditary syndrome developed PCCRC. One patient diagnosed with PCCRC after the detection of CRC was labeled as having Syndrome X, and two patients had oligopolyposis with negative multigene panel. There were no PCCRC cases in patients with inflammatory bowel disease (IBD). Our department has a high-risk CRC unit as well as IBD monographic clinic in which patients undergo close surveillance, which may be the reason for this incidence of PCCRC in these patients. Two patients did have previous CRC. We are aware of the limitations of this study. First, the retrospective design could have some influence on the root-cause analysis, especially in the PCCRC categorization, where more detailed information is needed. This was reflected in the moderate agreement between the two endoscopists. Second, this study was performed in a limited period of time (CRCs diagnosed within two years), and therefore, the number of PCCRCs is small. Third, this is a single-center study, which limits the generalization of our results. However, similar results have been reported by other authors regarding root-cause analysis and categorization of PCCRC.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1,5</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">In conclusion, the WEO recommendations for cause-root analysis and categorization are useful for detecting areas for improvement to reduce PCCRC rates. In this study, most PCCRCs were avoidable, and efforts should be made to decrease PCCRC rates. Our results suggest that in approximately half of the patients with PCCRC, a relevant lesion in the previous colonoscopy was missed despite an adequate examination. A higher awareness, technical skills, and training to recognize subtle lesions are warranted. Quality metrics such as photodocumentation should also be improved.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Authors’ contributions</span><p id="par0200" class="elsevierStylePara elsevierViewall">Conception and design: Antonio Zebenzuy Gimeno-García, David Nicolás Pérez.</p><p id="par0205" class="elsevierStylePara elsevierViewall">Data collection: Anjara Hernández-Pérez, Federica Benítez-Zafra, Noemi Segura, Isaber Betancor.</p><p id="par0210" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: Noemi Hernández-Alvarez, Antonio Zebenzuy Gimeno-García, Eduardo Salido.</p><p id="par0215" class="elsevierStylePara elsevierViewall">Drafting of the manuscript: Antonio Zebenzuy Gimeno-García, Manuel Hernández Guerra, David Nicolás Pérez.</p><p id="par0220" class="elsevierStylePara elsevierViewall">Critical revision: Enrique Quintero, Manuel Hernández Guerra.</p><p id="par0225" class="elsevierStylePara elsevierViewall">Final approval of the article: Antonio Zebenzuy Gimeno-García.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Ethical considerations</span><p id="par0230" class="elsevierStylePara elsevierViewall">The protocol was approved by the local ethics committee of Hospital Universitario de Canarias CHUC_2021_115.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicts of interest</span><p id="par0235" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2162165" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Aims" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1834332" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xpalclavsec1834331" "titulo" => "Abbreviations" ] 3 => array:3 [ "identificador" => "xres2162164" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1834333" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Data collection" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Root-cause analysis" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "PCCRC categorization" ] 3 => array:3 [ "identificador" => "sec0030" "titulo" => "Outcomes" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Primary outcome" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Secondary outcomes" ] ] ] 4 => array:2 [ "identificador" => "sec0045" "titulo" => "Statistical analysis" ] ] ] 7 => array:3 [ "identificador" => "sec0050" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Root-cause analysis" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Categorization of PCCRC" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Potentially avoidable PCCRCs" ] ] ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Authors’ contributions" ] 10 => array:2 [ "identificador" => "sec0080" "titulo" => "Ethical considerations" ] 11 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-02-24" "fechaAceptado" => "2023-05-29" "PalabrasClave" => array:2 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1834332" "palabras" => array:3 [ 0 => "Postcolonoscopy colorectal cancer" 1 => "World Endoscopy Organization" 2 => "Root-cause analysis" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec1834331" "palabras" => array:6 [ 0 => "WEO" 1 => "PCCRC" 2 => "CRC" 3 => "BBPS" 4 => "ESGE" 5 => "SE" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1834333" "palabras" => array:3 [ 0 => "Cáncer colorrectal poscolonoscopia" 1 => "Organización Mundial de Endoscopia" 2 => "Análisis de causas potenciales" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Aims</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The World Endoscopy Organization (WEO) recommends that endoscopy units implement a process to identify postcolonoscopy colorectal cancer (PCCRC). The aims of this study were to assess the 3-year PCCRC rate and to perform root-cause analyses and categorization in accordance with the WEO recommendations.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cases of colorectal cancers (CRCs) in a tertiary care center were retrospectively included from January 2018 to December 2019. The 3-year and 4-year PCCRC rates were calculated. A root-cause analysis and categorization of PCCRCs (interval and type A, B, C noninterval PCCRCs) were performed. The level of agreement between two expert endoscopists was assessed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 530 cases of CRC were included. A total of 33 were deemed PCCRCs (age 75.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.5 years; 51.5% women). The 3-year and 4-year PCCRC rates were 3.4% and 4.7%, respectively. The level of agreement between the two endoscopists was acceptable either for the root-cause analysis (<span class="elsevierStyleItalic">k</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.958) or for the categorization (<span class="elsevierStyleItalic">k</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.76).</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The most plausible explanations of the PCCRCs were 8 “likely new PCCRCs”, 1 (4%) “detected, not resected”, 3 (12%) “detected, incomplete resection”, 8 (32%) “missed lesion, inadequate examination”, and 13 (52%) “missed lesion, adequate examination”. Most PCCRCs were deemed noninterval Type C PCCRCs (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>17, 51.5%).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">WEO recommendations for root-cause analysis and categorization are useful to detect areas for improvement. Most PCCRCs were avoidable and were likely due to missed lesions during an otherwise adequate examination.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Aims" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La Organización Mundial de Endoscopia recomienda que las unidades de endoscopia implementen procedimientos para identificar el cáncer colorrectal poscolonoscopia (CCRPC). Los objetivos de este estudio fueron evaluar la tasa de CCRPCP a los 3 y 4 años, realizar un análisis de causalidad potencial y categorización siguiendo las recomendaciones de la Organización Mundial de Endoscopia.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron retrospectivamente los cánceres colorrectales diagnosticados de enero de 2018 a diciembre de 2019 en un hospital de tercer nivel. Se calculó la tasa de CCRPC a 3 años. Se realizó un análisis de causalidad potencial y categorización de los CCRPC (intervalo y CCRPC de no intervalo tipo A, B, C). Se evaluó la concordancia entre dos endoscopistas expertos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 530 cánceres colorrectales. Un total de 33 se consideraron CCRPC (edad 75,8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9,5 años; 51,5% mujeres). La tasa de CCRPC a 3 y 4 años fue del 3,4% y 4,7% respectivamente. La concordancia entre los dos endoscopistas fue aceptable para el análisis de causalidad (k<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,958) y para la categorización (k<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,76). La explicación probable de los CCRPC fue: 8 «probable CCRPC <span class="elsevierStyleItalic">de novo</span>», 1 (4%) «detectado, no resecado», 3 (12%) «detectado, resección incompleta», 8 (32%) «no detectado, examen inadecuado» y 13 (52%) «no detectado, examen adecuado». La mayoría de los CCRPC se consideraron de no intervalo tipo C (N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>17, 51,5%).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Las recomendaciones de la Organización Mundial de Endoscopia para el análisis de causalidad y la categorización son útiles para detectar áreas de mejora. La mayoría de los CCRPC eran evitables debido a lesiones no detectadas a pesar de realizar un examen adecuado.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">These authors contributed equally to this work.</p>" "identificador" => "fn0005" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2217 "Ancho" => 3341 "Tamanyo" => 319217 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Algorithm for root-cause analysis.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> *Sensitivity analysis taking into account proper photodocumentation of the cecum or ilium and rectal retroversion. **Sensitivity analysis taking into account the resection of nonadvanced adenomas in the same segment of the postpolypectomy colorectal cancer. #Sensitivity analysis considering an advanced adenoma located in the neighboring segment as a potential source of postcolonoscopy colorectal cancer.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 900 "Ancho" => 3341 "Tamanyo" => 167418 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Categorization of the postcolonoscopy colorectal cancer based on the World Endoscopy Organization consensus statements.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">PCCRC</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic"><</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">3 years (N, %)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">PCCRC</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic"><</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">4 years (N, %)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">PCCRC</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic"><</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">10 years (N, %)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (6.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age (mean</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">±</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SE</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleItalic">)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.5 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Gender (female) (N, %)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (51.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Indication (previous colonoscopy) (N, %)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CRC<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> screening \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (36.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Postpolypectomy surveillance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (24.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rectal bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (12.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Familial screening \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Abnormal imaging examination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CRC surveillance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Loss of weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Staging (N, %)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stage I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (42.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stage II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (21.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stage III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (30.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stage IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Morning shift (N, %)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (60.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Adenoma (previous colonoscopy) (N, %)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (51.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nonadvanced adenoma (<span class="elsevierStyleItalic">N</span>, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (24.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Advanced adenoma (<span class="elsevierStyleItalic">N</span>, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Advanced and nonadvanced adenomas (<span class="elsevierStyleItalic">N</span>, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (18.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Adenoma morphology (previous colonoscopy) (N, %)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Flat adenomas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (12.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Protruding adenomas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (24.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Flat and protruding adenomas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (15.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Complete colonoscopy</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleItalic">(previous colonoscopy) (N, %)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (84.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Photodocumentation</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a><span class="elsevierStyleItalic">(previous colonoscopy) (N, %)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (39.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Adequate bowel cleansing</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">f</span></a><span class="elsevierStyleItalic">(previous colonoscopy) (N, %)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (72.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3562871.png" ] ] ] "notaPie" => array:6 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">PCCRC: postcolonoscopy colorectal cancer.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">SE: standard deviation.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">CRC: colorectal cancer.</p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Visualization of the cecum or ileum.</p>" ] 4 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "e" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Cecum and rectal retroflexion.</p>" ] 5 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "f" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Boston Bowel Preparation Scale<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>2 points per segment.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Postcolonoscopy colorectal cancer rates and basal characteristics of the patients included.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">*Not otherwise specified.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Location (N, %)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cecum/ascendent colon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (54.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Transverse colon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Distal colon and rectum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (39.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Macroscopic appearance (N, %)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pedunculated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Exophytic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (48.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ulcerated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (48.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Tumor size (mean, SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.22<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Histologic type</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NOS* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (66.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucinous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (27.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serrated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Tumor grade (N, %)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low grade \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (54.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate grade \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (18.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High grade \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (27.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Microscopic tumor extension</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pT1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (24.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pT2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (24.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pT3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (39.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pT4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (12.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Number of positive lymph nodes</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.09<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.95 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Vascular lymphatic invasion (N, %)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Perineural invasion (N, %)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (12.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Tumor budding (N, %)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (84.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intermediate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (12.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Tumor deposits (N, %)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (21.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Resection margins (N, %)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 (97) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3562870.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the postpolypectomy colorectal cancers.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilization and reproducibility of World Endoscopy Organization post-colonoscopy colorectal cancer algorithms: retrospective analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. 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Journal Information
Original article
Postcolonoscopy colorectal cancer: Prevalence, categorization and root-cause analysis based on the World Endoscopic Organization system
Cáncer colorrectal poscolonoscopia. Prevalencia, categorización y análisis de las causas subyacentes basado en las recomendaciones de la Organización Mundial de Endoscopia
Antonio Z. Gimeno-Garcíaa,b,c,1,
, Anjara Hernández-Péreza,1, Federica Beníteza, Noemi Seguraa, David Nicolás-Péreza, Enrique Quinterob,c, Noemi Hernández-Álvareza, Isabel Betancord, Eduardo Salidod, Manuel Hernández-Guerraa,b,c
Corresponding author
a Servicio de Gastroenterología, Hospital Universitario de Canarias, Spain
b Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Spain
c Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de La Laguna, Tenerife, Spain
d Servicio de Anatomía Patológica, Hospital Universitario de Canarias, Spain