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Introduction: Patients with inflammatory bowel diseases (IBDs) of the colon are at an increased risk of colorectal cancer (CRC). This study investigates the epidemiology of IBD-CRC and its outcomes. Methods: Using population data from the English National Health Service held in the CRC data repository, all CRCs with and without prior diagnosis of IBD (Crohn's, ulcerative colitis, IBD unclassified, and IBD with cholangitis) between 2005 and 2018 were identified. Descriptive analyses and logistic regression models were used to compare the characteristics of the 2 groups and their outcomes up to 2 years. Results: Three hundred ninety thousand six hundred fourteen patients diagnosed with CRC were included, of whom 5,141 (1.3%) also had a previous diagnosis of IBD. IBD-CRC cases were younger (median age at CRC diagnosis [interquartile range] 66 [54–76] vs 72 [63–79] years [P < 0.01]), more likely to be diagnosed with CRC as an emergency (25.1% vs 16.7% [P < 0.01]), and more likely to have a right-sided colonic tumor (37.4% vs 31.5% [P < 0.01]). Total colectomy was performed in 36.3% of those with IBD (15.4% of Crohn's, 44.1% of ulcerative colitis, 44.5% of IBD unclassified, and 67.7% of IBD with cholangitis). Synchronous (3.2% vs 1.6% P < 0.01) and metachronous tumors (1.7% vs 0.9% P < 0.01) occurred twice as frequently in patients with IBD compared with those without IBD. Stage-specific survival up to 2 years was worse for IBD-associated cancers. Conclusion: IBD-associated CRCs occur in younger patients and have worse outcomes than sporadic CRCs. There is an urgent need to find reasons for these differences to inform screening, surveillance, and treatment strategies for CRC and its precursors in this high-risk group.

BACKGROUND The Joint Advisory Group on Gastrointestinal Endoscopy basic skills in colonoscopy (BSC) course was introduced in 2009 to improve colonoscopy training within the United Kingdom, but its impact on trainee performance is unknown. AIM To assess whether attendance of the BSC could improve colonoscopy performance. METHODS Trainees awarded colonoscopy certification between 2011-2016 were stratified into 3 groups according to pre-course procedure count (< 70, 70-140 and > 140). Study outcomes, comprising the unassisted caecal intubation rate (CIR) and the performance indicator of colonic intubation (PICI), were studied over the 50 procedures pre and post- course. Interrupted time series analyses were performed to detect step-change changes attributable to the course. RESULTS A total of 369 trainees with pre-course procedure counts of < 70 (n = 118), 70-140 (n = 121) and > 140 (n = 130) were included. Over the 50 pre-course procedures, significant linear improvements in CIR were found, with average increases of 4.2, 3.6 and 1.7 percentage points (pp) per 10 procedures performed in the < 70, 70-140 and > 140 groups respectively (all P < 0.001). The < 70 procedures group saw a significant step-change improvement in CIR, increasing from 46% in the last pre-course procedure, to 51% in the first procedure post-course (P = 0.005). The CIR step-change was not significant in the 70-140 (68% to 71%; P = 0.239) or > 140 (86% to 87%; P = 0.354) groups. For PICI, significant step-change improvements were seen in all three groups, with average increases of 5.6 pp (P < 0.001), 5.4 pp (P = 0.003) and 3.9 pp (P = 0.014) respectively. CONCLUSION Attendance of the BSC was associated with a significant step-change improvement in PICI, regardless of prior procedural experience. However, CIR data suggest that the optimal timing of course attendance appears to be at earlier stages of training (< 70 procedures).

ObjectiveTo describe and investigate the potential causes of the isolated caecal patch lesion, a previously undescribed endoscopic phenomenon of a lesion fulfilling endoscopic and histopathological criteria for chronic inflammatory bowel disease but without evidence of similar inflammatory pathology elsewhere at colonoscopy.MethodsCases were collected prospectively by one specialist gastrointestinal pathologist over a 10-year period. Full endoscopic and histopathological analysis was undertaken and follow-up sought to understand the likely cause(s) of the lesions.ResultsSix cases are described. Two had very close links with ulcerative colitis, one predating the onset of classical distal disease and the other occurring after previous demonstration of classical distal ulcerative colitis. Two occurred in younger patients and we postulate that these lesions may predict the subsequent onset of chronic inflammatory bowel disease. Finally two can be reasonably attributed to the effects of non-steroidal inflammatory agent therapy.ConclusionsCaecal patch lesions can be demonstrated in isolation. Despite the strong association of caecal patch lesions with ulcerative colitis, solitary lesions may well have disparate causes but nevertheless possess a close relationship with chronic inflammatory bowel disease.

Background Diagnostic timeliness in cancer patients is important for clinical outcomes and patient satisfaction but, to-date, continuous monitoring of diagnostic intervals in nationwide incident cohorts has been impossible in England. Methods We developed a new methodology for measuring the secondary care diagnostic interval (SCDI - first relevant secondary care contact to diagnosis) using linked cancer registration and healthcare utilisation data. Using this method, we subsequently examined diagnostic timeliness in colorectal and lung cancer patients (2014–15) by socio-demographic characteristics, diagnostic route and stage at diagnosis. Results The approach assigned SCDIs to 94.4% of all incident colorectal cancer cases [median length (90th centile) of 25 (104) days] and 95.3% of lung cancer cases [36 (144) days]. Advanced stage patients had shorter intervals (median, colorectal: stage 1 vs 4 - 34 vs 19 days; lung stage 1&2 vs 3B&4 - 70 vs 27 days). Routinely referred patients had the longest (colorectal: 61, lung: 69 days) and emergency presenters the shortest intervals (colorectal: 3, lung: 14 days). Comorbidities and additional diagnostic tests were also associated with longer intervals. Conclusion This new method can enable repeatable nationwide measurement of cancer diagnostic timeliness in England and identifies actionable variation to inform early diagnosis interventions and target future research.

This White Paper shares guidance on the important principles of training endoscopy teachers, the focus of an American Society for Gastrointestinal Endoscopy (ASGE)/World Endoscopy Organization Program for Endoscopic Teachers and Leaders of Endoscopic Training held at the ASGE Institute for Training and Technology. Key topics included the need for institutional support and continuous skills development, the importance of consensus and consistency in content and approach to teaching, the role of conscious competence and content breakdown into discreet steps in effective teaching, defining roles of supervisors versus instructors to ensure teaching consistency across instructors, identification of learning environment factors and barriers impacting effective teaching, and individualized training that incorporates effective feedback and adapts with learner proficiency. Incorporating simulators into endoscopy teaching, applying good endoscopy teaching principles outside the endoscopy room, key principles of hands-on training, and effective use of simulators and models in achieving specific learning objectives were demonstrated with rotations through hands-on simulator stations as part of the program. A discussion of competency-based assessment was followed by live sessions in which attendees applied endoscopy teaching principles covered in the program. Conclusions highlighted the need for the following: formal training of endoscopy teachers to a level of conscious competence, incorporation of formal training structures into existing training curricula, intentional teaching preparation, feedback to trainees and instructors alike aimed at improving performance, and competency-based trainee assessment. The article is intended to help motivate individuals who play a role in training other endoscopists to develop their teaching abilities, promote discussions about endoscopy training, and engage both endoscopy trainers and trainees in a highly rewarding learning process that is in the best interest of patients.

The European Society of Gastrointestinal Endoscopy (ESGE) together with the United European Gastroenterology (UEG) recently developed a short list of performance measures for small-bowel endoscopy (i.e. small-bowel capsule endoscopy and device-assisted enteroscopy) with the final goal of providing endoscopy services across Europe with a tool for quality improvement. Six key performance measures both for small-bowel capsule endoscopy and for device-assisted enteroscopy were selected for inclusion, with the intention being that practice at both a service and endoscopist level should be evaluated against them. Other performance measures were considered to be less relevant, based on an assessment of their overall importance, scientific acceptability, and feasibility. Unlike lower and upper gastrointestinal endoscopy, for which performance measures had already been identified, this is the first time small-bowel endoscopy quality measures have been proposed. ispartof: UNITED EUROPEAN GASTROENTEROLOGY JOURNAL vol:7 issue:5 pages:614-641 ispartof: location:England status: published

Background Direct Observation of Procedural Skills (DOPS) is an established competence assessment tool in endoscopy. In July 2016, the DOPS scoring format changed from a performance-based scale to a supervision-based scale. We aimed to evaluate the impact of changes to the DOPS scale format on the distribution of scores in novice trainees and on competence assessment. Methods We performed a prospective, multicenter (n = 276), observational study of formative DOPS assessments in endoscopy trainees with ≤ 100 lifetime procedures. DOPS were submitted in the 6-months before July 2016 (old scale) and after (new scale) for gastroscopy (n = 2998), sigmoidoscopy (n = 1310), colonoscopy (n = 3280), and polypectomy (n = 631). Scores for old and new DOPS were aligned to a 4-point scale and compared. Results 8219 DOPS (43 % new and 57 % old) submitted for 1300 trainees were analyzed. Compared with old DOPS, the use of the new DOPS was associated with greater utilization of the lowest score (2.4 % vs. 0.9 %; P Conclusions Endoscopy assessors applied a greater range of scores using the new DOPS scale based on degree of supervision in two cohorts of trainees matched for experience. Our study provides construct validity evidence in support of the new scale format.

The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). We recommend that endoscopy services across Europe adopt the following seven key and one minor performance measures for EUS and ERCP, for measurement and evaluation in daily practice at center and endoscopist level: 1 Adequate antibiotic prophylaxis before ERCP (key performance measure, at least 90 %); 2 Antibiotic prophylaxis before EUS-guided puncture of cystic lesions (key performance measure, at least 95 %); 3 Bile duct cannulation rate (key performance measure, at least 90 %); 4 Tissue sampling during EUS (key performance measure, at least 85 %); 5 Appropriate stent placement in patients with biliary obstruction below the hilum (key performance measure, at least 95 %); 6 Bile duct stone extraction (key performance measure, at least 90 %); 7 Post-ERCP pancreatitis (key performance measure, less than 10 %). 8 Adequate documentation of EUS landmarks (minor performance measure, at least 90 %).This present list of quality performance measures for ERCP and EUS recommended by ESGE should not be considered to be exhaustive: it might be extended in future to address further clinical and scientific issues.

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a short list of key performance measures for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). We recommend that endoscopy services across Europe adopt the following seven key and one minor performance measures for EUS and ERCP, for measurement and evaluation in daily practice at centre and endoscopist level: 1 Adequate antibiotic prophylaxis before ERCP (key performance measure, at least 90%); 2 antibiotic prophylaxis before EUS-guided puncture of cystic lesions (key performance measure, at least 95%); 3 bile duct cannulation rate (key performance measure, at least 90%); 4 tissue sampling during EUS (key performance measure, at least 85%); 5 appropriate stent placement in patients with biliary obstruction below the hilum (key performance measure, at least 95%); 6 bile duct stone extraction (key performance measure, at least 90%); 7 post-ERCP pancreatitis (key performance measure, less than 10%); and 8 adequate documentation of EUS landmarks (minor performance measure, at least 90%). This present list of quality performance measures for ERCP and EUS recommended by the ESGE should not be considered to be exhaustive; it might be extended in future to address further clinical and scientific issues. ispartof: UNITED EUROPEAN GASTROENTEROLOGY JOURNAL vol:6 issue:10 pages:1448-1460 ispartof: location:England status: published

Significant efforts have been dedicated to defining what constitutes high-quality endoscopy. These efforts, centered on developing, refining, and implementing procedure-associated quality indicators1, 2, 3, 4, 5 have been helpful in promoting best practices among endoscopists and providing evidence-based care for our patients. At the same time, the American Society for Gastrointestinal Endoscopy (ASGE) has generated programming to assist physicians and allied healthcare professionals in understanding how to translate quality concepts into practice. With this work, we now have a stronger sense of how to measure quality at the patient and procedural level. A critical component of high-quality endoscopy services relates to the site of the procedure: the endoscopy unit. Unlike many procedure-associated quality indicators, evidenced-based indicators used to measure the quality of endoscopy units are lacking. Outside of the United States, the United Kingdom’s National Health Services developed the Global Rating Scale (GRS) in 20046 with the dual aims of enhancing quality while developing uniformity in endoscopy unit processes and operations. This scoring system was the first to assess service at the level of the endoscopy unit and has been instrumental in reducing wait times, identifying service gaps, increasing patient satisfaction, and reducing adverse events within endoscopy units in the United Kingdom.7 Additionally, the GRS has demonstrated that measuring an endoscopy unit parameter repeatedly and incorporating it into a quality improvement program leads to improvement for many indicators.6, 7, 8 Use of the GRS has spread with modification and adoption for use in other countries across Europe8, 9 and Canada.10, 11 However, there are limitations with the GRS. Whether improvements in 1 particular indicator are correlated with other areas of endoscopy unit performance and outcomes cannot be ascertained from the GRS data. Also, the process for developing and reaching consensus on the GRS indicators has varied extensively in their rigor and breadth of stakeholder participation. To date, no such effort to identify and promote endoscopy unit–level quality indicators has been performed in the United States. A compendium of quality indicators for endoscopy units in the United States is needed to strengthen programming around the promotion of quality and to give endoscopy units an organizational framework within which they can direct their efforts. As healthcare reimbursement in the United States becomes more dependent upon demonstration of performance and quality, endoscopists, governing organizations, payers, and patients will be looking for guidance on endoscopy unit–wide performance. Consequently, the ASGE convened a taskforce whose primary objectives were to (1) develop a comprehensive document that identifies key quality indicators for endoscopy units as defined by the literature and expert opinion and (2) achieve consensus on these quality indicators from important stakeholders involved in endoscopy unit operations and quality improvement (Video 1, available online at www.VideoGIE.org).

The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for lower gastrointestinal endoscopy. We recommend that endoscopy services across Europe adopt the following seven key performance measures for lower gastrointestinal endoscopy for measurement and evaluation in daily practice at a center and endoscopist level: 1 Rate of adequate bowel preparation (minimum standard 90 %); 2 Cecal intubation rate (minimum standard 90%); 3 Adenoma de-tection rate (minimum standard 25%); 4 Appropriate polypectomy technique (minimum standard 80%); 5 Complication rate (minimum standard not set); 6 Patient experience (minimum standard not set); 7 Appropriate post-polypectomy surveillance recommendations (minimum standard not set). Other identified performance measures have been listed as less relevant based on an assessment of their importance, scientific acceptability, feasibility, usability, and comparison to competing measures.

Objective: Cecal intubation rate (CIR) is known to be inversely associated with interval colorectal cancer (CRC) risk. Cecal intubation may be achieved by the use of force and sedation jeopardizing patient safety. The Performance Indicator of Colonic Intubation (PICI) is defined as the proportion of colonoscopies achieving cecal intubation with use of ≤2 mg midazolam and no-mild patient-experienced discomfort. We aimed (i) to measure the variation of PICI between colonoscopists and colonoscopy units; (ii) to assess the correlation between the individual components of PICI; and (iii) to evaluate the association between PICI and commonly used performance indicators. Materials and methods: For the period 1 July 2015 through 30 June 2017 of the prevalent round of the Danish FIT-based CRC screening program, we included colonoscopies performed at four units in the Central Denmark Region within 60 days after a positive FIT-test. The PICI variation was evaluated using rates and ranges. Correlations between individual PICI components were assessed using Pearson correlation coefficients. Polyp detection rate (PDR), Adenoma detection rate (ADR), Polyp retrieval rate (PRR) and Withdrawal time (WT) were assessed within PICI quartiles. Results: The overall PICI was 78.7% with substantial variation between colonoscopists (40.0–91.9%) and units (72.6–82.0%). CIR was significantly correlated with patient-experienced comfort (r = 0.49, n = 73, p

Background The post-colonoscopy colorectal cancer (PCCRC) rate is a key quality indicator for colonoscopy. Previously published PCCRC rates have been difficult to compare owing to differences in methodology. The primary aim of this study was to compare Danish PCCRC rates internationally and to calculate Danish PCCRC rates using the World Endoscopy Organization (WEO) consensus method for future comparison. The secondary aim was to identify factors associated with PCCRC. Methods National registries were used to examine the risk of PCCRC. The Danish 3-year rate of PCCRC (PCCRC-3yr) was calculated using previously published methods from England, Sweden, and the WEO. Poisson regression analysis was performed to identify factors associated with PCCRC. Results The Danish PCCRC-3yr was significantly higher than the rate in the English NHS (relative risk [RR] 1.12, 95 % confidence interval [CI] 1.05 – 1.19) and Sweden (RR 1.15, 95 %CI 1.06 – 1.24). The Danish PCCRC-3yr based on the WEO consensus method fell from 22.5 % in 2001 to 7.9 % in 2012. The multivariable Poisson regression model found PCCRC to be significantly associated with diverticulitis (RR 3.25, 95 %CI 2.88 – 3.66), ulcerative colitis (RR 3.44, 95 %CI 2.79 – 4.23), hereditary cancer (age Conclusions The PCCRC-3yr was higher in Denmark than in comparable countries. Differences in colonoscopist training, background, and certification are possible contributing factors. A review of colonoscopist training and certification in Denmark, and continuous audit and feedback of colonoscopist performance may reduce PCCRC-3yr.

Introduction The JAG Basic Skills in Colonoscopy Course is a mandated JAG course designed to help standardise colonoscopy training within the UK. The course is a component of the certification criteria, but the impact of the course on subsequent trainee performance is unknown. We aimed to evaluate colonoscopy performance, as measured using colonoscopy completion metrics, in relation to course attendance. Methods Trainees awarded colonoscopy certification between 201–016 were stratified into 3 groups according to the number of procedures performed prior to the course, 140 procedures. The study outcomes comprised the unassisted caecal intubation rate (CIR) and the Performance Indicator of Colonic Intubation (PICI),1 a composite measure encompassing caecal intubation, sedation and discomfort. Within each group, outcomes rates were calculated for each of the 50 procedures before and after the course. Interrupted time series models were then used to detect step-change improvements occurring after the course. Results A total of 369 trainees were included in the analysis, who performed 140 (N=130) procedures prior to the course. Over the 50 procedures prior to the course, all three groups saw significant linear improvements in CIR, with an average increase of 4.2, 3.6 and 1.7 percentage points for every 10 procedures in the 140 groups, respectively (all p 140 procedure groups, respectively. For PICI, all three groups saw a significant step change improvement, with average increases of 5.6 (p 140 groups, respectively. Based on pre-course trends, the immediate improvement in PICI following course attendance was equivalent to that stemming from performing an additional 1–0 procedures. Conclusions Attendance of the JAG Basic Skills Colonoscopy Course appears to improve PICI in all trainees. CIR data suggests that the optimal timing of course attendance appears to be at earlier stages of colonoscopy training ( References Valori RM, et al. Endoscopy 2018; PMID:28753700

Introduction Computed tomography colonography (CTC) is the gold standard radiological investigation for colorectal cancer screening. The Post-Imaging Colorectal Cancer (PICRC) rate (i.e. colorectal cancers that develop after a negative CTC) is a key quality indicator of CTC; however, PICRC rates have not been previously reported in a national programme. The Word Endoscopy Organisation has, through a consensus process, agreed a standard methodology for calculating PICRC rates to enable international benchmarking (1). This rate (which the WEO terms PICRC-3y) is calculated by dividing the PICRCs detected 6 months to 3 years after a negative CTC (false negatives) by the sum of the true positives (defined by CTCs with a cancer diagnosis within 6 months) and false negatives (PICRCs). This study aimed to determine the rate of PICRC-3y in the English National Health Service (NHS) Bowel Cancer Screening Programme (BCSP). Methods Data from each Bowel Cancer Screening Programme (BCSP) CTC is entered into a national database, the Bowel Cancer Screening System (BCSS). All colorectal adenocarcinomas, within and outside the BCSP, are validated and registered by the National Cancer Registration and Analysis Service (NCRAS). This retrospective observational study interrogated these databases to identify BCSP true positive and false negative CTCs. CTCs were included regardless of whether they were preceded or followed by a colonoscopy within a screening episode. Results Of the 8 PICRCs, 3 were detected at subsequent BCSP procedures, one at 1 year surveillance, and 2 following re-invitation for screening at 2 years. Five were detected outside the BCSP. Conclusions The PICRC–3y in the BCSP is higher than the rate in the published literature (4.4%)(2) and the corresponding rate for Post Colonoscopy Colorectal Cancer (PCCRC) over the same period (2.5%). CTC is commonly reserved for patients who are either deemed unsuitable for colonoscopy, or in whom colonoscopy has failed, meaning that there are likely to be substantial differences between the populations undergoing each examination. Because CTC and colonoscopy are performed in different populations, those having CTC more likely to be frailer with greater co–morbidity, the higher rate of PICRC when compared to PCCRC has to be interpreted with caution and may relate to the difficulty of investigating such patients, who may not be fit enough for, or refuse an intervention even if a lesion is found. References Beintaris I, et al. United European Gastroenterology Journal Vol 5 Issue 5_Suppl PO436 Obaro AE, et al. Lancet Gastroenterol Hepatol3(5) 32–36

Introduction In the UK, endoscopy certification is administered by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG). Since 2011, certification for upper and lower gastrointestinal endoscopy has been awarded via a national (JETS) e-portfolio to the main training specialties of: gastroenterology, gastrointestinal surgeons (GS) and non-medical endoscopists (NME). Trends in endoscopy certification and differences between trainee specialties were analyzed. Methods This prospective UK-wide observational study identified trainees awarded gastroscopy, sigmoidoscopy, colonoscopy (provisional and full) certification between June 2011 – 2017. Trends in certification, procedures and time-to-certification, and key performance indicators (KPIs) in the 3-month pre- and post-certification period were compared between the three main training specialties. Results Three thousand one hundred fifty-seven endoscopy-related certifications were awarded to 1928 trainees from gastroenterology (52.3 %), GS (28.4 %) and NME (16.5 %) specialties. During the study period, certification numbers increased for all modalities and specialties, particularly NME trainees. For gastroscopy and colonoscopy, procedures-to-certification were lowest for GS (P Conclusion Despite variations among trainee specialties, average pre- and post-certification KPIs for certified trainees met national standards, suggesting that JAG certification is a transparent benchmark which adequately safeguards competency in endoscopy training.

Objective: From the prevalent round of the Danish FIT-based colorectal cancer (CRC) screening program, we aimed (i) to evaluate the quality of recorded data and (ii) to characterize the colonoscopies by measuring variation in performance indicators between colonoscopists and assessing the ratio between adenoma detection rate (ADR) and polyp detection rate (PDR). Materials and methods: This study included screening colonoscopies performed in Central Denmark Region within 60 days of a positive FIT-result from 1 July 2015 through 30 June 2017. The participants were the colonoscopists, performing these procedures. The quality indicators cecal intubation rate (CIR), PDR, polyp retrieval rate (PRR), ADR and withdrawal time (WT) were evaluated. ADR/PDR ratios were calculated. Results: The concordance between the recorded data and the colonoscopy reports showed Kappa values in the range of 0.47–0.97. The overall CIR was 90.6% (range 73.7%–100%), PDR: 51.9% (range 18.4%–70.2%), PRR: 94.6% (range 69.6%–100%), ADR (conventional adenomas): 50.6% (range 18.4%–70.2%), ADRx (conventional adenomas, traditional serrated adenomas and sessile serrated lesions with dysplasia): 50.9% (range 18.4%–70.2%) and the mean WT was 11.3 min (range 4.5–24.9 min). The ADR/PDR ratio was 92.8% (95% CI: 92.0%–93.6%) and the ADRx/PDR ratio was 93.2% (95% CI: 92.4%–93.9%). Conclusion: Data quality was generally high. We found considerable variation in performance indicators between colonoscopists reflecting the potential for improvement. Further, our findings revealed that the PDR might be a good proxy for ADR in the context of the prevalent round of FIT-based CRC screening programs.

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have identified quality of endoscopy as a major priority and we described our rationale for this in a first manuscript that also addressed the methodology of the quality initiative process.1 The identification of upper gastrointestinal (UGI) performance measures presents a considerable challenge, in contrast to the situation with colonoscopy for instance, where several performance measures (inspection time, adenoma detection rate, and interval cancers, among others) have been identified over the last decade.2,3 Following the Quality in UGI Endoscopy meeting held in Lisbon in 2013, it was clear that there was a need to identify performance measures for the UGI tract, and that quality standards could be identified although there is a paucity of evidence. This lack of evidence helps however to identify research priorities for the development of clinical trials that will further validate and substantiate the implementation of performance measures. The aim therefore of the UGI working group was twofold: (a) to identify performance measures for UGI endoscopy; (b) to identify the evidence or absence of evidence that would develop the research priorities in this field. We used an innovative methodology to facilitate the quality initiative process, which combined a thorough search and standardized evaluation of the available evidence for each clinical question, followed by a Delphi process (http://is.njit.edu/pubs/delphibook/delphibook.pdf) using an online platform.4,5 This online platform permitted iterative rounds of modification and comment by all members of the UGI working group until agreement was reached on the performance measure. We now report these newly identified performance measures.

Endoscopy training has traditionally been accomplished by an informal process in the endoscopy unit that parallels apprenticeship training seen in other areas of professional education. Subsequent to an audit, a series of interventions were implemented in the English National Health Service to support both service delivery and to improve endoscopy training. The resulting training centers deliver a variety of hands-on endoscopy courses, established in parallel with the roll out of a colon cancer screening program that monitors and documents quality outcomes among endoscopists. The program developed a 'training the trainer' module that subsequently became known as the Training the Colonoscopy Trainer course (TCT). Several years after its implementation, colonoscopy quality outcomes in the UK have improved substantially. The core TCT program has spread to other countries with demonstration of a marked impact on endoscopy training and performance. The aim of this chapter is to describe the principles that underlie effective endoscopy training in this program using the TCT as an example. While the review focuses on the specific example of colonoscopy training, the approach is generic to the teaching of any technical skill; it has been successfully transferred to the teaching of laparoscopic surgery as well as other endoscopic techniques.

A modern endoscopy service delivers high volume procedures that can be daunting, embarrassing and uncomfortable for patients [1]. Endoscopy is hugely beneficial to patients but only if it is performed to high standards [2]. Some consequences of poor quality endoscopy include worse outcomes for cancer and gastrointestinal bleeding, unnecessary repeat procedures, needless damage to patients and even avoidable death [3]. New endoscopy technology and more rigorous decontamination procedures have made endoscopy more effective and safer, but they have placed additional demands on the service. Ever-scarcer resources require more efficient, higher turnover of patients, which can be at odds with a good patient experience, and with quality and safety. It is clear from the demands put upon it, that to deliver a modern endoscopy service requires effective leadership and team working [4]. This chapter explores what constitutes effective leadership and what makes great clinical teams. It makes the point that endoscopy services are not usually isolated, independent units, and as such are dependent for success on the organisations they sit within. It will explain how endoscopy services are affected by the wider policy and governance context. Finally, within the context of the collection of papers in this edition of Best Practice & Research: Clinical Gastroenterology, it explores the potentially conflicting relationship between training of endoscopists and service delivery. The effectiveness of leadership and teams is rarely the subject of classic experimental designs such as randomized controlled trials. Nevertheless there is a substantial literature on this subject within and particularly outside healthcare [5]. The authors draw on this wider, more diffuse literature and on their experience of delivering a Team Leadership Programme (TLP) to the leaders of 70 endoscopy teams during the period 2008-2012. (Team Leadership Programme Link-http://www.qsfh.co.uk/Page.aspx?PageId=Public).

The aim of this study was to determine the number of OGDs (oesophago-gastro-duodenoscopies) trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time.OGD data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy (JAG) in the UK. All trainees were included unless they were known to have a baseline experience of20 procedures or had submitted data for20 procedures. The primary outcome measure was OGD completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance. The number of OGDs required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine which factors were independently associated with OGD completion, a mixed effects logistic regression model was constructed with OGD completion as the outcome variable.Data were analysed for 1255 trainees over 288 centres, representing 243 555 OGDs. By moving average method, trainees attained a 95% completion rate at 187 procedures. By LC-Cusum analysis, after 200 procedures,90% trainees had attained a 95% completion rate. Total number of OGDs performed, trainee age and experience in lower GI endoscopy were factors independently associated with OGD completion.There are limited published data on the OGD learning curve. This is the largest study to date analysing the learning curve for competency acquisition. The JAG competency requirement for 200 procedures appears appropriate.

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision. ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients.

To develop standards for high quality in gastrointestinal (GI) endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all GI endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE's viewpoints on the requirements for high-quality endoscopy reporting systems in GI endoscopy. Recommendations 1 Endoscopy reporting systems must be electronic. 2 Endoscopy reporting systems should be integrated into hospitals' patient record systems. 3 Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources. 4 Endoscopy reporting systems shall restrict the use of free-text entry to a minimum, and be based mainly on structured data entry. 5 Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated. 6 Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically. 7 Endoscopy reporting systems shall facilitate the inclusion of information on histopathology of detected lesions, patient satisfaction, adverse events, and surveillance recommendations. 8 Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format. 9 Endoscopy reporting systems must include data fields for key performance indicators as defined by quality improvement committees. 10 Endoscopy reporting systems must facilitate changes in indicators and data entry fields as required by professional organizations.

Background & Aims Postcolonoscopy colorectal cancer (PCCRC) is CRC diagnosed after a colonoscopy in which no cancer was found. A consensus article from the World Endoscopy Organization (WEO) proposed an approach for investigating and categorizing PCCRCs detected within 4 years of a colonoscopy. We aimed to identify cases of PCCRC and the factors that cause them, test the WEO system of categorization, quantify the proportion of avoidable PCCRCs, and propose a target rate for PCCRCs detected within 3 years of a colonoscopy that did not detect CRC. Methods We performed a retrospective analysis of 107 PCCRCs identified at a single medical center in England from January 1, 2010, through December 31, 2017 using coding and endoscopy data. For each case, we reviewed clinical, pathology, radiology, and endoscopy findings. Using the WEO recommendations, we performed a root-cause analysis of each case, categorizing lesions as follows: possible missed lesion, prior examination adequate; possible missed lesion, prior examination inadequate; detected lesion, not resected; or likely incomplete resection of previously identified lesion. We determined whether PCCRCs could be attributed to the colonoscopist for technical or decision-making reasons, and whether the PCCRC was avoidable or unavoidable, based on the WEO categorization and size of tumor. The endoscopy reporting system provided performance data for individual endoscopists. Results Of the PCCRCs identified, 43% were in high-risk patients (those with inflammatory bowel disease, previous CRC, previous multiple large polyps, or hereditary cancer syndromes) and 66% were located distal to the hepatic flexure. There was no correlation between postcolonoscopy colorectal tumor size and time to diagnosis after index colonoscopy. Bowel preparation was poor in 19% of index colonoscopies, and only 36% of complete colonoscopies had adequate photodocumentation of completion. Development of 73% of PCCRCs was determined to be affected by technical endoscopic factors, 17% of PCCRCs by administrative factors (follow-up procedures delayed/not booked by administrative staff), and 27% of PCCRCs by decision-making factors. Twenty-seven percent of PCCRCs were categorized as possible missed lesion, prior examination adequate; 58% as possible missed lesion, prior examination inadequate; 8% as detected lesion, not resected; and 7% as incomplete resection of previously observed lesion; 89% were deemed to be avoidable. Conclusions In a retrospective analysis of PCCRCs, using the WEO system of categorization, we found 43% to occur in high-risk patients; this might be reduced with more vigilant surveillance. Measures are needed to reduce technical, decision-making, and administrative factors. We found that 89% of PCCRCs may be avoidable. If half of avoidable PCCRCs could be prevented, the target rate of 2% for the PCCRC-3y (cancer diagnosed between 6 and 36 months after index colonoscopy) benchmark would be achievable.

It is nearly 20 years since the national colonoscopy audit demonstrated poor performance of colonoscopy and inadequate training of colonoscopists.1 In 2004, a National Confidential Enquiry into Perioperative Deaths in endoscopy identified major deficiencies in the service.2 These two seminal publications identified what the endoscopy workforce in the UK already knew: the service was falling well behind endoscopy services in other countries and delivering poor care to patients. There were multiple problems: inadequate facilities and equipment; long waits and poor patient experience; inadequately trained staff; minimal or no processes to ensure appropriate patient selection and safety; and no monitoring of quality. During the period 2001–2010, the endoscopy service in England received substantial national investment targeted at modernising the service and improving training, especially colonoscopy training.3 During the same period, bowel cancer screening programmes were implemented in each of the four nations. The challenge was to use the new money and impetus from screening wisely: to deliver clear improvements; and to achieve a sustainable position when investment was withdrawn. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) has played a pivotal role in addressing this challenge, directing the service and empowering it to change. The JAG was created in 1994 to support endoscopist training. Prior to 2001, its main responsibility was …

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve. We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation. Stakeholders include patients and their advocacy groups; service leaders; staff, including endoscopists; professional societies; payers; and regulators. ispartof: UNITED EUROPEAN GASTROENTEROLOGY JOURNAL vol:7 issue:1 pages:21-44 ispartof: location:England status: published

Introduction PCCRC is a key quality indicator for the detection and prevention of colorectal adenocarcinoma (CRC). It is not known whether rates of PCCRC are changing over time. There is limited evidence of factors associated with PCCRC that might be amenable to quality improvement interventions. This study investigated trends in rates of PCCRC in the NHS in England; the extent of variation between NHS trusts; and potential causal associations with PCCRC. Methods Using linked national Hospital Episode Statistics and National Cancer Registration and Analysis Service data all individuals who had undergone a colonoscopy procedure between 1/1/2006 and 31/12/2012 and who developed a CRC to 31/12/2015 were identified. NHS trust provider status and potential associations with PCCRC were included in the analysis. International consensus methodology was used to calculate the PCCRC – 3 year rate (PCCRC-3 yr).1 2 Colonoscopies were labelled as true positive (CRC within 0 to 6 months of the procedure), false negative (CRC within 6 to 36 months) and true negative (CRC beyond 36 months). The PCCRC-3 yr rate was calculated as: false negatives/(true positive +false negative) x 100%. The PCCRC-3 yr rate was calculated for each year from 2006 to 2012. In addition, the rate in each colonoscopy provider was calculated, and organisations grouped using quintiles. PCCRC rates were calculated in relation to patient and tumour characteristics. Results Between 2006 and 2012 1 08 908 colonoscopies followed by a diagnosis of CRC were identified. Of these, 93 240 (86%) were labelled true positive, 7781 (7%) were false negatives, and 7887 (7%) were true negative tests. There was a significant reduction in PCCRC-3 yr rates, from 8.6% in 2006 to 7.5% in 2012 (Chi2 for trend p Conclusion There has been a significant reduction in PCCRC-3 yr rates from 2006 to 2012, likely to be related to improvements in colonoscopic quality: particularly improved caecal intubation and bowel preparation resulting in improved lesion recognition and removal. There appears to be unwarranted variation of PCCRC-3 yr rates across NHS trusts. Reasons for this variation need to be explored and subject to quality improvement projects. Evidence from this study can be used to help target those at highest risk of PCCRC. References . Morris EJA, et al. Gut2014;64:1248–56. . Beintaris I, et al. UEG J2017;5:PO436.

Introduction CCRC is cancer arising 6–36 months after a negative colonoscopy. PCCRCs arise from incompletely or unresected lesions, or are missed or new lesions. PCCRC rates are a key quality marker for colonoscopy. The aim of this study was to test the utility of the World Endoscopy Organisation (WEO) algorithm for categorising avoidable factors leading to PCCRC.1 Methods All PCCRCs diagnosed between 01/06/10 and 31/12/16 at one trust were identified by cross-referencing coding and endoscopy data. A root-cause analysis was undertaken for each using the WEO algorithm (figure 1). Results 27 PCCRCs were reviewed (age 37–85, median 70). 5 patients had inflammatory bowel disease (IBD), 20 diverticulosis and 1 Lynch syndrome. Chromoendoscopy was used in 1 IBD patient. Adenomas had previously been seen in the cancerous bowel segment in 8 cases (29.6%): 3/8 arose from resected lesions; and 5/8 from unresected lesions. 2/5 unresected lesions were deliberately not investigated further (patient/MDT decision). Bowel preparation was poor in 6 colonoscopies (22.2%). 24 were reported as complete, but only 12 had adequate caecal photographs (44.4%). Overall, follow-up procedures were delayed or not requested in 11 cases (40.7%). Conclusions Although the WEO algorithm is a useful tool for PCCRC categorisation, a category for conservatively managed cases is missing. Further, a judgement is still required to conclude whether a PCCRC was avoidable or unavoidable. In this cohort, 70% of PCCRCs (19/27) were probably avoidable; 5 possibly avoidable and 3 likely unavoidable. The following are influencing factors and possible means of addressing them: PCCRC rates are high in patients with existing colon pathology. Rates would reduce in certain groups with greater vigilance and use of chromoendoscopy. Surveillance timeframes were often breached. Effective processes should reduce delays. Bowel preparation was often poor. If these colonoscopies are not repeated, the decision should be recorded. Some adenomas were overlooked while endoscopists focussed on large polyps. Early repeat colonoscopy should be considered after complicated procedures. Photodocumentation was adequate in 44.4% of cases. Inadequate photos may be a marker for other shortcomings and repeat colonoscopy considered if caecal documentation is incomplete. These findings indicate that PCCRC rates could be reduced by up to 70% if avoidable factors are addressed. There is a need for quality improvement studies targeting these factors to quantify their impact on PCCRC rates. References 1. Beintaris I et al. UEG Journal. 2017;5:PO436

Introduction Colorectal cancer (CRC) risk is increased in those with inflammatory bowel disease (IBD). Guidelines advocate surveillance colonoscopy for patients with longstanding IBD. Post-colonoscopy colorectal cancer (PCCRC) is a key quality indicator of colonoscopy. There is limited data exploring the rate of PCCRC in those with IBD and potential risk factors associated with IBD-related PCCRC. This study explored national and individual hospital rates of IBD-related PCCRC in England since 2006. Further analysis explored potential associations with IBD-related PCCRC in order to inform future quality improvement interventions. Methods We identified all those who had undergone a colonoscopy between 1/1/2006 and 31/12/2012 and developed a CRC before 31/12/2015 using linked national Hospital Episode Statistics and National Cancer Registration and Analysis Service data. IBD cases were identified by relevant ICD-10 codes. Using international consensus guidelines1,2 the rate of PCCRC within 3 years (PCCRC-3 yr) was calculated as the number of false negative colonoscopies (within 6–36 months of CRC) divided by the sum of the true positive (within 6 months of CRC) and false negative colonoscopies. The IBD-associated PCCRC-3 yr rate in each NHS hospital trust in England was ranked and trusts were separated into quintiles. Factors associated with IBD-related PCCRC were investigated. Results Between 2006 and 2012 we identified 7781 PCCRC, 800 (10%) with a diagnosis of IBD. Nationally, the IBD-PCCRC-3 yr rate was 35%, and varied between hospital trusts with those in the lowest quintile having a mean, unadjusted rate of 19% (SD ±7%) compared to 52% (SD ±7%) in the highest quintile. PCCRC cases were younger at diagnosis (60 years compared to 66 years), were less likely to have diverticular disease (10% compared to 16%), and had undergone more previous colonoscopies when compared to detected cases (within 6 months of colonoscopy). There was no significant difference for sex, bowel location, deprivation score, or metachronous tumours. Conclusion PCCRC-3 yr in those with IBD is high, and accounted for 10% of all PCCRC-3 yr in England between 2006 and 2012. There is a wide variation in the unadjusted rates between NHS trusts in England that is unlikely to be explained by natural variation. There is an urgent need to investigate avoidable reasons for cancers in those with IBD to optimise surveillance and prevention of CRC in IBD.

Introduction Colonoscopy is an imperfect tool. The term ‘interval’ cancer refers to cancers diagnosed after a colorectal screening examination or test in which no cancer was detected, and before the date of the next recommended exam. From a colonoscopy Quality Assurance perspective, that term is too restrictive, hence the term Post Colonoscopy Colorectal Cancer (PCCRC) was developed, to incorporate non-screening settings. Methods Our goal was to provide a framework on terminology, identification, analysis and reporting of cancers appearing after a negative colonoscopy (PCCRCs) or computed tomographic colonography (Post-Imaging Colorectal Cancers/PICRCs). We based our methodology on the AGREE II tool. A team of gastroenterologists, pathologists, epidemiologists, a radiologist and a patient representative, formed a panel of 20 members. Following literature review, 402 articles provided background for statements, which were then subjected to anonymous voting (modified Delphi approach). The GRADE system was utilised to rate evidence. Results The final output consists of 21 statements, providing guidance on key aspects of PCCRC/PICRC, namely: Definitions/terminology (2 statements) (table 1) Qualitative review of cases/aetiology attribution (8 statements) (figure 1) Quantitative assessment/calculation of PCCRC rate (7 statements) Non–colonoscopic imaging of the colon (4 statements) The PCCRC rate is calculated as the number of PCCRCs divided by the total of the PCCRCs plus the number of detected cancers, expressed as a percentage. A Root-Cause-Analysis checklist, as well as a checklist to assist Peer Review of PCCRC manuscripts have also been developed. Conclusions This is the first consensus aiming to standardise terminology around PCCRC/PICRC, presenting a methodology for analysis of causation of PCCRC/PICRC and defining its potential role as a key quality indicator.

Introduction PCCRC rate is a key quality indicator of colonoscopy. The Word Endoscopy Organisation has reached consensus agreement to use one method for calculating 3 year PCCRC rates (termed PCCRC-3 y) to enable benchmarking of rates.1 This methodology, used previously by Morris et al.2, showed a PCCRC-3 y rate of 8.6% across the English National Health Service (NHS) from 2001–2007.2 with a rate of 7.3% in 2007. This study aimed to determine the rate of PCCRC-3 y in the English NHS Bowel Cancer Screening Programme (BCSP). Methods Data from each colonoscopy in the BCSP is entered into a national database, the Bowel Cancer Screening System. All colorectal adenocarcinomas, within and outside the BCSP, are validated and registered by the National Cancer Registration and Analysis Service. This retrospective observational study interrogated these databases to identify those BCSP colonoscopies detecting colorectal cancers within 6 months (true positive colonoscopies) and those BCSP colonoscopies in patients who subsequently developed a colorectal cancer 6 months – 3 years after the colonoscopy (false negatives) between 2006 and 2013. Conclusions The overall English NHS BCSP PCCRC–3 y rate from 2006–2010 is 3.1% – less than half the 7.3% PCCRC rate seen in the symptomatic English NHS for 2007, providing further evidence that high quality colonoscopy, such as that performed by screening–accredited colonoscopists in the BCSP, results in a lower rate of PCCRC.3 4 Despite the high quality of colonoscopy in the BCSP, PCCRCs still occur, showing the importance of vigilance during all colonoscopies. Diagnosis of >2000 colorectal cancers (true positive colonoscopies) each year indicates there is an adequate sample size for annual reporting of PCCRC–3 y rate within the BCSP and comparison with PCCRC–3 yr rates in symptomatic services. References 1. Beintaris I, et al. United European Gastroenterology Journal 5(5_Suppl):PO436. 2. Morris EJA et al. Gut 2014;0:1–9. 3. Corley DA, et al. N Engl. J Med 2014;370:1298–306. 4. Kaminski MF, et al. N Engl. J Med 2010;362:1795–803.

Background & Aims: Colonoscopy examination does not always detect colorectal cancer (CRC)— some patients develop CRC after negative findings from an examination. When this occurs before the next recommended examination, it is called interval cancer. From a colonoscopy quality assurance perspective, that term is too restrictive, so the term post-colonoscopy colorectal cancer (PCCRC) was created in 2010. However, PCCRC definitions and methods for calculating rates vary among studies, making it impossible to compare results. We aimed to standardize the terminology, identification, analysis, and reporting of PCCRCs and CRCs detected after other whole-colon imaging evaluations (post-imaging colorectal cancers [PICRCs]).\ud \ud \ud \ud Methods: A 20-member international team of gastroenterologists, pathologists, and epidemiologists; a radiologist; and a non-medical professional met to formulate a series of recommendations, standardize definitions and categories (to align with interval cancer terminology), develop an algorithm to determine most-plausible etiologies, and develop standardized methodology to calculate rates of PCCRC and PICRC. The team followed the Appraisal of Guidelines for Research and Evaluation II tool. A literature review provided 401 articles to support proposed statements; evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The statements were voted on anonymously by team members, using a modified Delphi approach.\ud \ud \ud \ud Results: The team produced 21 statements that provide comprehensive guidance on PCCRCs and PICRCs. The statements present standardized definitions and terms, as well as methods for qualitative review, determination of etiology, calculation of PCCRC rates, and non-colonoscopic imaging of the colon.\ud \ud \ud \ud Conclusions: A 20-member international team has provided standardized methods for analysis of etiologies of PCCRCs and PICRCs and defines its use as a quality indicator. The team provides recommendations for clinicians, organizations, researchers, policy makers, and patients.

Background: There is a lack of educational tools available for surgical teaching critique, particularly for advanced laparoscopic surgery. The aim was to develop and implement a tool that assesses training quality and structures feedback for trainers in the English National Training Programme for laparoscopic colorectal surgery. Methods: Semi-structured interviews were performed and analysed, and items were extracted. Through the Delphi process, essential items pertaining to desirable trainer characteristics, training structure and feedback were determined. An assessment tool (Structured Training Trainer Assessment Report—STTAR) was developed and tested for feasibility, acceptability and educational impact. Results: Interview transcripts (29 surgical trainers, 10 trainees, four educationalists) were analysed, and item lists created and distributed for consensus opinion (11 trainers and seven trainees). The STTAR consisted of 64 factors, and its web-based version, the mini-STTAR, included 21 factors that were categorised into four groups (training structure, training behaviour, trainer attributes and role modelling) and structured around a training session timeline (beginning, middle and end). The STTAR (six trainers, 48 different assessments) demonstrated good internal consistency (α = 0.88) and inter-rater reliability (ICC = 0.75). The mini-STTAR demonstrated good inter-item reliability (α = 0.79) and intra-observer reliability on comparison of 85 different trainer/trainee combinations (r = 0.701, p =

Objective Interval colorectal cancers (interval CRCs), that is, cancers occurring after a negative screening test or examination, are an important indicator of the quality and effectiveness of CRC screening and surveillance. In order to compare incidence rates of interval CRCs across screening programmes, a standardised definition is required. Our goal was to develop an internationally applicable definition and taxonomy for reporting on interval CRCs . Design Using a modified Delphi process to achieve consensus, the Expert Working Group on interval CRC of the Colorectal Cancer Screening Committee of the World Endoscopy Organization developed a nomenclature for defining and characterising interval CRCs . Results We define an interval CRC as a “colorectal cancer diagnosed after a screening or surveillance exam in which no cancer is detected, and before the date of the next recommended exam”. Guidelines and principles for describing and reporting on interval CRCs are provided, and clinical scenarios to demonstrate the practical application of the nomenclature are presented. Conclusions The Working Group on interval CRC of the World Endoscopy Organization endorses adoption of this standardised nomenclature. A standardised nomenclature will facilitate benchmarking and comparison of interval CRC rates across programmes and regions.