Medical-legal risks of incident cancers after clearing colonoscopy

Colonoscopy and polypectomy effectively reduce the incidence and mortality of colorectal cancer, but some patients present with fully developed cancer s within 1-4 yr of a colonoscopy that apparently cleared the colon of neopl asia. These events may result in medical-legal action against colonoscopist s, generally based on an assumption of negligent technical performance of t he procedure. Alternative explanations for the development of interval canc ers include variable growth rates of colorectal cancers, the inherent miss rate of the procedure even when optimal examination techniques are used, an d the possibility of flat lesions that are not readily detected by standard colonoscopic techniques. This paper discusses issues relevant to reduction of medical-legal risks associated with interval cancers after clearing col onoscopy. These issues include informed consent, documentation of cecal int ubation, appropriate description of preparation, documentation of examinati on time and technique, and attention to potential atypical neoplasms. (Am J Gastroenterol 2001.96:952-957. (C) 2001 by Am. Cell. of Gastroenterology).