Abstract
Introduction: Endoscopist performance is reflected by a metric known as the adenoma detection rate (ADR), or the ratio of colonoscopies with an adenomatous polyp removed compared to the total number of screening colonoscopies performed. An ADR of 25% is now endorsed as the benchmark to reduce the rate of interval colorectal cancer. Despite this, ADR has been shown to have weaknesses, such as the inability to distinguish any adenomas detected after the first in an examination, or that it does not account for proximal colon lesions which are known to account for a majority of interval colorectal cancers. The aim of this study is to analyze existing metrics and to create a novel metric which may account for some of the aforementioned weaknesses of ADR. Methods: We conducted a retrospective review of average-risk screening colonoscopies performed by 7 endoscopists over an 18-month period (June 1, 2013 to November 1st 2015). Patients with prior adenomas, colorectal surgery, IBD, suboptimal bowel preparation, or a family history of colorectal cancer were excluded. Our novel metric, LT5R, accounts for the number of small adenomas ( < 5mm) in the right colon as well as data for known metrics such as ADR, advanced-ADR (A-ADR), total adenomas detected, right-sided ADR (R-ADR), Sessile-Serrated ADR (SS-ADR), and right-sided Sessile-Serrated ADR (RSS-ADR). Chi-square and appropriate rank tests were used to compare the groups among the studied metrics. Results: Of the 4000 screening colonoscopies queried, 807 qualified for analysis. Endoscopists ADR ranged from 41-54%, but differences were not significant. Amongst known metrics, only R-ADR and SS-ADR were able to distinguish significant differences between endoscopists with p=0.022 and 0.018, respectively. Our novel metric, LT5R, was also able to distinguish differences between endoscopists, p=0.03. Conclusion: ADR alone may be insufficient to determine differences amongst endoscopists. Not only is ADR unable to account for adenomas detected after the first detected adenoma, it is also unable to account for adenomas in the right colon, where most interval cancers occur. However, our new metric, LT5R, incorporates the size, number, and location of adenomas in one metric. In this study, LT5R was able to find significant differences in endoscopist performance even amongst our high performing endoscopists. The key to our metric or any other performance metric is the ability to translate into improved outcomes in terms of interval cancer prevention.
Published Version
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