Sa1033 TIME TO RAISE THE BAR: A SYSTEMATIC REVIEW OF ADENOMA DETECTION RATE IN FIT POSITIVE POPULATIONS.

Abstract

Adenoma detection rate (ADR) is defined as the percentage of patients undergoing screening colonoscopy who have one or more adenoma detected and is a well-known quality indicator for colonoscopy. Recent ASGE guidelines recommend ADR of >35% in females and >45% in males undergoing colonoscopy for positive FIT test. However it is a weak recommendation with very low quality of evidence. To estimate the average threshold of ADR in patients with positive FIT test who undergo colonoscopy. Online databases including Medline, PubMed, Google Scholar and Embase were searched from inception to October 2017 by two investigators. References from the ASGE guidelines were manually searched to include additional data. Studies describing the adenoma detection rate in asymptomatic patients with positive FIT tests were included for this review. We used MedCalc Ver 17.9.7 to estimate the weighted outcome of ADR across various studies. Random effects model was used for weighing. A total of 34 studies were identified for full review after literature search, of which 17 studies were found to be eligible for this study. A total of 103090 patients were included in the final analysis. The range of ADR across studies was (36.75%-77.19%) with a median of 54.59%. The combined weighted ADR was 52.18%, (95% CI 49.97-54.38) . There was substantial heterogeneity between the studies likely due to the use of different cut off values of the positive FIT result and different populations studied. Average adenoma detection rate in patients with positive FIT test appears to be higher than benchmark set by ASGE. Higher quality studies with more uniform data are required to accurately establish ADR threshold in this population.Forest plot depicting confidence limits of mean ADR across different studies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)