A Survey of ADR Knowledge and Practices Among U.S. Gastroenterologists

Abstract

Introduction: The adenoma detection rate (ADR) is critical to quality screening colonoscopy. The risk, the extent and accuracy to which ADR is measured in clinical practice is largely unknown. We conducted a paid online survey to assess knowledge and practices regarding ADR. Methods: An electronic survey was distributed by Lightspeed (Lightspeed Health, New York, NY) in February 2018 to physicians in its database. To be eligible respondents were required to be board certified gastroenterologists, perfrom > 80 colonoscopies per month, and in practice after fellowship for 3 to 35 years. 250 gastroenterologists completed a questionnaire (Table 1). Results: 39% of respondents were unaware that ADR applies only to screening colonoscopies and 76% incorrectly answered that ADR measurements include sessile serrated polyps/adenomas. Regarding the ADR threshold, only 37% correctly answered that a minimum acceptable threshold has been set at ≥ 25%. 51% of physicians believe the threshold is set at a national ADR average of 25%, 75% of physicians ranked ADR as being of high importance, and the majority answered that increasing ADR decreased interval cancer rates and that ADR correlates with decreased CRC deaths. Overall, 80% reported tracking their ADRs. The majority of those that did not track ADR reported that a busy practice was the main obstacle, and 68% reported that lack of time was the major barrier to increasing ADR. Caps, chromoendoscopy, and good bowel preparation were viewed as being relatively valuable for improving ADR (this is correct except for caps). HD colonoscopes and education were considered to have relatively little value (HD is associated with higher ADR in meta-analyses and education has been effective in randomized trials and uncontrolled trials) 57% of physicians reported not sharing their ADR information with their patients, and 59% reported that none of their patients in the last 6 months have asked for their ADR. Conclusion: A high percent of U.S. gastroenterologists report measuring their ADR, but there were knowledge gaps regarding the correct definition of ADR, which could result in inaccurate reporting. The importance of ADR as a validated quality measure is well understood, but understanding of which methods are proven to increase ADR is deficient. Patients exert minimal pressure on colonoscopists to measure ADR.