Is Polypectomy Rate a Good Quality Metric Substitute for Adenoma Detection Rate During Screening Colonoscopy?

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Introduction: Screening colonoscopy and polypectomy is an effective tool for colorectal cancer (CRC) prevention. Several quality measures have been proposed to assess quality. Because detection and removal of adenoma is the ultimate goal, Adenoma detection rate (ADR), is proposed as a central quality measure. However, ADR calculation necessitates burdensome correlation between endoscopy findings and histology evaluation and it is not readily available at the end of the procedure. Limited data suggest polypectomy rate (PR) correlates with ADR. Aim: Compare the PR and ADR in a screening and surveillance colonoscopy cohort and evaluate if this can serve as a surrogate measure for quality. Methods: We conducted a retrospective study of patients underwent screening or surveillance colonoscopy performed by 15 endoscopists between Jan 1, 2012 and Dec 31, 2012. Patients were identified through CPT and ICD-9 codes from the billing database. Patients 50 years or older with good to excellent bowel prep were included in the study. High-risk screening, diagnostic, fair to poor bowel prep, and incomplete exams were exclusion criteria. We calculated the ADR, PR, and we used Spearman correlation coefficient for different colon segment and according to sex. Results: The study included 1,286 colonoscopies with mean age of 59±7.3 years; 26.9% of patients had at least 1 polyp. The mean number of adenoma and polyp per patient was 0.3222 (95% CI 0.278, 0.366) and 0.536 (95% CI 0.465, 0.686), respectively. The ADR for the 15 endoscopists range from 6-32%. The ADR for males was 25.6% and 16.3% for females. PR of 30% in males and 23% in females correlate with the minimum suggested ADR by major society guidelines. The correlation between overall PR and ADR (r=0.52). The Spearman rank-correlation for PR and ADR in the proximal colon for males and females were 0.63 (P<0.0001) and 0.78 (P<0.0001), respectively and (r=0.28; P=0.002 and r=0.24; P=0.009) for the distal colon. Conclusion: There is moderate correlation between overall PR and ADR in our cohort. The correlation is stronger for females and proximal colon segment. Polypectomy rate could be a valid quality metric for screening colonoscopy.