Abstract
BackgroundAdenoma Detection Rate (ADR) is a validated colonoscopy quality indicator. In addition to overall ADR, Distal and Proximal Adenoma Detection Rates may provide important colonoscopy quality information. The goal of this study is to determine the association between distal and proximal adenoma detection (AD) and to identify factors contributing to overall, distal, and proximal AD.MethodsThis is a retrospective cohort study of patients with a noted family history of CRC or positive fecal occult blood test who underwent a screening colonoscopy at a regional colorectal cancer (CRC) screening center between May 2009 and December 2011. Data regarding patient demographics, procedure details, endoscopist characteristics and polyp histology were captured. The main outcomes measured were overall, distal, and proximal AD.Results1907 patients were included. The median age was 60 years and 42% were male. Endoscopist median overall ADR was 25% (30% male, 21% female). Endoscopist distal ADR was only modestly associated with their proximal ADR (Spearman Rank: 0.51 p = 0.11). Highest overall ADR (29 to 45%) was found for endoscopists whose distal and proximal ADRs were above the group median. In multivariate analysis, factors associated with overall, distal, and proximal AD included age, sex, and endoscopist practicing experience.ConclusionInclusion of distal and proximal ADRs, in addition to overall ADR, in colonoscopy quality assessment provides the more accurate feedback on endoscopist performance.
Highlights
Adenoma Detection Rate (ADR) is a validated colonoscopy quality indicator
The quality indicator currently recommended by the American Society for Gastrointestinal Endoscopy is Adenoma Detection Rate (ADR) [4, 5]
In this study, we demonstrate a notable variability in endoscopist distal and proximal adenoma detection
Summary
Adenoma Detection Rate (ADR) is a validated colonoscopy quality indicator. In addition to overall ADR, Distal and Proximal Adenoma Detection Rates may provide important colonoscopy quality information. Multiple studies have shown significant polyp and adenoma miss rates for colonoscopies [2], as well as lower than expected reduction in mortality for proximal colorectal cancers [3]. These factors have highlighted the necessity for effective quality indicators to monitor and advance colon cancer screening programs. An endoscopist’s ADR has been shown to be associated with overall patient risk of interval colorectal cancer (colorectal cancer diagnosed within a few years of colonoscopy) [7, 8], risk of distal interval colorectal cancer [9], and risk of fatal interval colorectal cancer [8]
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