Adenoma Detection Rate In Colonoscopy Research Articles

The impact of linked color imaging on adenoma detection rate in colonoscopy: a systematic review and meta-analysis.

Colorectal cancer prevention relies on surveillance colonoscopy, with the adenoma detection rate as a key factor in examination quality. Linked color imaging (LCI) enhances lesion contrast and improves the examination performance. This systematic review and meta-analysis aimed to evaluate the effect of LCI on adenoma detection rate in adults who underwent colonoscopy. We searched the Medline, PubMed, BIREME, LILACS, and Scientific Electronic Library Online databases for randomized controlled trials comparing the use of LCI versus white light (WL), published up to March 2023. The outcomes included lesion characteristics, number of adenomas per patient, and the additional polyp detection rate. Sixteen studies were included in the analysis, which showed that LCI was more accurate than WL in detecting adenomas, with an increased number of adenomas detected per patient. Although LCI performed well in terms of lesion size, morphology, and location, the subgroup analyses did not reveal any statistically significant differences between LCI and WL. The addition of LCI did not result in significant improvements in the detection of serrated lesions, and there were no differences in the withdrawal time between groups. LCI has been shown to be effective in detecting colonic lesions, improving the number of adenomas detected per patient and improving polyp detection rate without negatively affecting other quality criteria in colonoscopy.

Analysis of adenoma detection rate of colonoscopy among trainees.

To analyze adenoma detection rate (ADR) and related quality indicators of colonoscopy among trainees and make recommendations for appropriate colonoscopy training. ADR and related indicators of colonoscopies performed by 3 trainees and 5 colonoscopy experts between March and November 2022 were analyzed. These indicators were analyzed in both the entire patients and the screening/surveillance group. In addition, the training period of the 3 trainees was divided into 3 sections, and the changes in these indicators were examined. The mean ADR of the 3 trainees was 50.6%. In the screening/surveillance group, the mean ADR of the 3 trainees was 51.8%, showing no significant difference from the experts' ADR (53.4%). When the training period was divided into 3 sections and analyzed in the screening/surveillance group, the mean ADR of the trainees gradually increased to 49.4%, 52.6%, and 53.6%, respectively; however, the difference was insignificant. Analyzing each trainee's ADR, there was a significant difference among the 3 trainees (58.5% vs. 44.7% vs. 50.2%, P=0.008). However, in the third section of the training period, the 3 trainees' ADRs were 53.0%, 49.2%, and 57.3%, respectively, showing no significant difference (P=0.606). In the early stages of training, the ADR was higher than recommended; however, there were variances in ADR between individuals. As the training period passed, the ADR became similar at the expert level, whereas the difference in ADR between trainees decreased. Therefore, efforts to increase ADR should be made actively from the beginning of training and continued during the training period.

Adenoma Detection Rate after Positive Stool-Based Screening in a U.S. Population

Abstract Introduction and Objectives Over the past two decades, advancements in screening programs have led to a decrease in the incidence and mortality rates of colorectal cancer. The recommended benchmark for primary screening colonoscopy adenoma detection rate (ADR) is 25%. However, recent research supports higher ADR benchmarks following positive stool testing. Findings from a Dutch screening program have suggested higher ADRs in fecal immunochemical test positive patients with an inverse relationship with interval cancer development. Our study aims to assess ADRs in a U.S. patient population with positive stool screenings and investigate any correlation to occurrences of interval cancers. Materials and Methods Data from all positive stool-based screening participants who subsequently underwent colonoscopy at a tertiary care center between 2017 and 2021 were collected. A retrospective chart review was performed to determine the ADR and interval colon cancers. Results From a total of 120 patients (32 fecal occult blood test [FOBT] positive patients, 43 fecal immunochemical test [FIT] positive patients, 45 FIT-DNA-positive patients), the average ADR was 35%. Nonadvanced polyps were the most identified adenomas at 78.6%. No interval colorectal cancer cases were identified. There was a clear difference in ADR between stool-testing methods, with FIT-DNA showing higher ADRs than FIT and FOBT. Conclusion Endoscopists should recognize the importance of higher ADR targets in colonoscopies conducted after positive stool-based screening as a means to maintain high-quality colonoscopy standards.

Single Versus Second Observer vs Artificial Intelligence to Increase the ADENOMA Detection Rate of Colonoscopy—A Network Analysis

Background and AimsScreening colonoscopy has significantly contributed to the reduction of the incidence of colorectal cancer (CRC) and its associated mortality, with adenoma detection rate (ADR) as the quality marker. To increase the ADR, various solutions have been proposed including the utilization of Artificial Intelligence (AI) and employing second observers during colonoscopies. In the interest of AI improving ADR independently, without a second observer, and the operational similarity between AI and second observer, this network meta-analysis aims at evaluating the effectiveness of AI, second observer, and a single observer in improving ADR.MethodsWe searched the Medline, Embase, Cochrane, Web of Science Core Collection, Korean Citation Index, SciELO, Global Index Medicus, and Cochrane. A direct head-to-head comparator analysis and network meta-analysis were performed using the random-effects model. The odds ratio (OR) was calculated with a 95% confidence interval (CI) and p-value < 0.05 was considered statistically significant.ResultsWe analyzed 26 studies, involving 22,560 subjects. In the direct comparative analysis, AI demonstrated higher ADR (OR: 0.668, 95% CI 0.595–0.749, p < 0.001) than single observer. Dual observer demonstrated a higher ADR (OR: 0.771, 95% CI 0.688–0.865, p < 0.001) than single operator. In network meta-analysis, results were consistent on the network meta-analysis, maintaining consistency. No statistical difference was noted when comparing AI to second observer. (RR 1.1 (0.9–1.2, p = 0.3). Results were consistent when evaluating only RCTs. Net ranking provided higher score to AI followed by second observer followed by single observer.ConclusionArtificial Intelligence and second-observer colonoscopy showed superior success in Adenoma Detection Rate when compared to single-observer colonoscopy. Although not statistically significant, net ranking model favors the superiority of AI to the second observer.

Impact of a Time-Related Benchmark on the Adenoma Detection Rate in Surveillance Colonoscopy: A STROBE Statement-Oriented Cross-Sectional Cohort Study.

Colorectal adenomas are precursor lesions of globally increasing colorectal cancer. Hence, a high adenoma detection rate in colonoscopy is pivotal. We investigated the clinical impact of stratified colonoscopy observation time combined with observation time/intubation time ratio on the detection of colorectal adenomas. We conducted a single-center retrospective study including 369 consecutive patients who underwent colonoscopy following fecal immunochemical tests between May 2021 and April 2022. The primary outcome measure was the impact of the stratified observation time and observation time/ intubation time ratio (category 1: <6.0 minutes and <1.0, category 2: <6.0 minutes and ≥1.0, category 3: ≥6.0 minutes and <1.0, and category 4: ≥6.0 minutes and ≥1.0) on adenoma detection rate. Cecum intubation was obtained in 367 patients (99.5%). Adenomas were detected in 226 patients (61.2%). From the univariate analysis, age ≥53 years, habitual alcohol intake, colonoscopy attachment (+), and observation time with observation time/intubation time ratio categories 3 and 4 were determined as significant factors for adenoma detection rate. From the logistic regression analysis, age ≥ 53 years (odds ratio: 4.86, 95% CI: 2.25-10.52), habitual alcohol intake (odds ratio: 2.26, 95% CI: 1.33-3.82), category 3 (odds ratio: 3.66, 95% CI: 1.81-7.45), and category 4 (odds ratio: 5.60, 95% CI: 2.92-10.73) were significant factors for adenoma detection rate. We propose the observation time with observation time/intubation time ratio combined benchmark (with categories' thresholds based on observation time >6 minutes and scope withdrawal time exceeding intubation time [observation time/intubation time ratio > 1]) as a novel colonoscopy quality indicator. These findings represent an important educational message for endoscopists.

Neoplasia Diagnosis After Multi-target Stool DNA Is Enhanced Among Lowest Baseline Detectors.

Variation in colorectal neoplasia detection limits the effectiveness of screening colonoscopy. By evaluating neoplasia detection rates of individual colonoscopists, we aimed to quantify the effects of pre-procedural knowledge of a positive (+) multi-target stool DNA (mt-sDNA) on colonoscopy quality metrics. We retrospectively identified physicians who performed a high volume of + mt-sDNA colonoscopies; colorectal neoplasia at post-mt-sDNA colonoscopy was recorded. These colonoscopists were stratified into quartiles based on baseline adenoma detection rates. Baseline colonoscopy adenoma detection rates and sessile serrated lesion detection rates were compared to post-mt-sDNA colonoscopy neoplasia diagnosis rates among each quartile. Withdrawal times were measured from negative exams. During the study period (2014-17) the highest quartile of physicians by volume of post-mt-sDNA colonoscopies were evaluated. Among thirty-five gastroenterologists, their median screening colonoscopy adenoma detection rate was 32% (IQR, 28-39%) and serrated lesion detection rate was 13% (8-15%). After + mt-sDNA, adenoma diagnosis increased to 47% (36-56%) and serrated lesion diagnosis increased to 31% (17-42%) (both p < 0.0001). Median withdrawal time increased from 10 (7-13) to 12 (10-17) minutes (p < 0.0001) and was proportionate across quartiles. After + mt-sDNA, lower baseline detectors had disproportionately higher rates of adenoma diagnosis in female versus male patients (p = 0.048) and higher serrated neoplasia diagnosis rates among all patients (p = 0.0092). Knowledge of + mt-sDNA enriches neoplasia diagnosis compared to average risk screening exams. Adenomatous and serrated lesion diagnosis was magnified among those with lower adenoma detection rates. Awareness of the mt-sDNA result may increase physician attention during colonoscopy. Pre-procedure knowledge of a positive mt-sDNA test improves neoplasia diagnosis rates among colonoscopists with lower baseline adenoma detection rates, independent of withdrawal time.

Speedometer for withdrawal time monitoring during colonoscopy: a clinical implementation trial

Objectives Meticulous inspection of the mucosa during colonoscopy, represents a lengthier withdrawal time, but has been shown to increase adenoma detection rate (ADR). We investigated if artificial intelligence-aided speed monitoring can improve suboptimal withdrawal time. Methods We evaluated the implementation of a computer-aided speed monitoring device during colonoscopy at a large academic endoscopy center. After informed consent, patients ≥18 years undergoing colonoscopy between 5 March and 29 April 2021 were examined without the use of the speedometer, and with the speedometer between 29 April and 30 June 2021. All colonoscopies were recorded, and withdrawal time was assessed based on the recordings in a blinded fashion. We compared mean withdrawal time, percentage of withdrawal time ≥6 min, and ADR with and without the speedometer. Results One hundred sixty-six patients in each group were eligible for analyses. Mean withdrawal time was 9 min and 6.6 s (95% CI: 8 min and 34.8 s to 9 min and 39 s) without the use of the speedometer, and 9 min and 9 s (95% CI: 8 min and 45 s to 9 min and 33.6 s) with the speedometer; difference 2.3 s (95% CI: −42.3–37.7, p = 0.91). The ADRs were 45.2% (95% CI: 37.6–52.8) without the speedometer as compared to 45.8% (95% CI: 38.2–53.4) with the speedometer (p = 0.91). The proportion of colonoscopies with withdrawal time ≥6 min without the speedometer was 85.5% (95% CI: 80.2–90.9) versus 86.7% (95% CI: 81.6–91.9) with the speedometer (p = 0.75). Conclusions Use of speed monitoring during withdrawal did not increase withdrawal time or ADR in colonoscopy. ClinicalTrials.gov Identifier NCT04710251

SP1.1.11Is polyp detection rate a suitable surrogate measure for adenoma detection rate in colonoscopy?

Abstract Aims The Joint Advisory Group on GI Endoscopy (JAG) has set key quality indicators for colonoscopy, which includes an adenoma detection rate of a minimum of 15%. Given the difficulty in reporting adenoma detection rate, JAG have stated that polyp detection rate is accepted as a surrogate measure. Our aim was to assess whether polyp detection rate can be used as a substitute marker for adenoma detection, by examining the histology of samples taken as polyps to determine what proportion are truly adenomas. Methods The pathology department provided a registry of all histological samples taken from the colon or rectum during a one-year period April 2017 to April 2018. These samples were cross-referenced with the endoscopy report to assess which were identified as “polyps” by the performing endoscopist. The pathology report was then reviewed to determine what the histological conclusion was for each “polyp”. Results A total of 1601 colorectal histology samples were reviewed, taken by 32 different endoscopists. 451 of these were identified as polyps by the performing endoscopist. On histological review 153 (33.9%) were not adenomas of the colon or rectum. Common alternative histological diagnoses were hyperplastic polyp, inflammatory polyp and normal tissue. Rarer alternative histological diagnoses were melanosis coli, submucosal leiomyoma and endometriosis of the rectum. Conclusions Polyp detection rate which is used as a surrogate marker for adenoma detection rate is an inaccurate measure of colonoscopy quality.

Cost-effectiveness of adding Endocuff® to standard colonoscopies for interval colorectal cancer screening.

Background and aims: Higher screening colonoscopy adenoma detection rates (ADRs) correlate with reduced risk of interval colorectal cancer (CRC). The Endocuff® device has been shown to improve ADRs compared to standard colonoscopy (SC). This cost-effectiveness analysis compared interval CRC screening using Endocuff®-assisted colonoscopy (EC) vs SC.Methods: A decision-analytic Markov model followed patients through screening, CRC diagnosis, progression, remission, and death. ADRs, CRC progression, and utilities were from literature. CRC incidence, stage distribution, and mortality were from the Surveillance, Epidemiology, and End Results (SEER) and SEER-Medicare linked databases. Screening and annual patient costs were from public databases and literature. Endocuff® device average sales price was applied. Lifetime device and medical costs were evaluated separately for device purchaser, health plan, and accountable care organization (ACO) perspectives.Results: Consistent use of EC instead of SC was expected to reduce lifetime risks of interval CRC and related death by 0.98% and 0.19%, respectively, preventing one case per 102 patients and one death per 526 patients. Survival and quality-of-life (QoL) improved by 0.025 life-years and 0.011 quality-adjusted life-years (QALYs) per patient on average. EC instead of SC led to incremental cost-effectiveness ratios to the device purchaser of $4,421 per life-year gained and $9,843 per QALY gained, and $199 or $87 average cost-savings per patient to the health plan or ACO, respectively.Conclusion: Endocuff® for screening colonoscopies was expected to reduce interval CRC incidence and death, improve QoL, and be cost-effective to the device purchaser and cost-saving to a health plan or ACO.

Correlation Between Polyp and Adenoma Detection Rate in Trainee Endoscopists

Introduction: The adenoma detection rate (ADR) is a widely accepted quality benchmark for screening colonoscopy, but calculation requires labor-intensive manual confirmation of histology. Previous studies have shown that the polyp detection rate (PDR) correlates well with ADR and may serve as a surrogate benchmark, although the ADR/PDR ratio may vary by colonic segment. In this study, we assessed the relationship between PDR and ADR in colonoscopies performed by trainees, for whom a surrogate benchmark may be a more practical method of tracking performance. Additionally, we evaluated the relationship between PDR and sessile serrated polyp (SSPDR) and advanced adenoma detection rates (AADR). Methods: We examined all outpatient colonoscopies performed by trainees at a VA facility from 8/16/16-12/29/17. We excluded incomplete procedures and those with Boston Bowel Preparation Scale scores less than 2 in any segment. Variables collected included patient demographics, year of fellowship, and endoscopic and histologic findings. Results: Table 1 shows patient characteristics, trainee status, and overall findings in 814 colonoscopies. Our population was predominantly (44%) black. The majority (88%) of procedures were performed for screening or surveillance, and most (47%) were performed by second-year fellows. The overall PDR, ADR, SSPDR, and AADR were 77%, 57%, 3%, and 17%. Table 2 shows the PDR, ADR, SSPDR, AADR, and the respective ratios overall as well as by colonic segment and year of training. The overall ADR/ PDR ratio was 0.74. The ratio was similar in the right (0.77) and transverse colon (0.75) but lower in the left colon (0.52). The same pattern was seen for the overall SSPDR/PDR and AADR/PDR ratios. When stratified by year of training, the overall ratios were consistent and a similar decline in ratios from the right to the left colon was observed in most cases. Notably, the AADR/PDR ratio in the right colon was substantially higher for third-year fellows, which suggests training may improve the efficiency of detecting advanced adenomas in the right colon. Conclusion: The overall ADR/PDR ratio in our study was higher than previously reported, which may reflect the predominantly male veteran population and the presence of a supervising physician. The overall ratios did not vary by year of training and but did decrease in the left colon. These results provide valuable preliminary data for how the PDR can be used to calculate the ADR, SSPDR, and AADR for trainee endoscopists.222_A Figure 1. Abbreviation: IQR, inter-quartile range a Advanced adenoma: any adenoma ≥10 mm in size, with villous component, or with high grade dysplasia OR any sessile serrated polyp ≥10 mm in size or with dysplasia222_B Figure 2. Abbreviations: ADR, adenoma detection rate; PDR, polyp detection rate; SSPDR, sessile serrated polyp detection rate; AADR, advanced adenoma detection rate.

Impact of Fellow Involvement and Fellowship Training Year on Adenoma Detection Rate: A Single Tertiary Institution Study

Introduction: It has been reported in the literature that gastroenterology fellow involvement during colonoscopy improves the adenoma detection rate (ADR), thus improving quality of colon cancer screening. [2, 3] We performed a review of colonoscopy procedures at a single teaching hospital to compare fellow adenoma removal percentages with those reported in the literature. [1, 3] Methods: We performed a retrospective chart analysis of the electronic medical record and collected data from colonoscopies performed between January 1, 2017 and December 31, 2017. Patients with documented familial adenomatous polyposis, Lynch syndrome, BRCA1 gene mutation, inflammatory bowel disease or gastrointestinal bleeding were excluded. We studied patient demographics, age, gender, race, indication for colonoscopy, particulars of the performing attending, fellow participation and adequacy of bowel prep were also documented. Results: We collected data from 623 colonoscopies performed at our institution. Out of total 623 colonoscopies, 48.6% (N= 303) were performed for average risk screening and 31.9% (N=199) were performed due to history of colon polyps. The next most common indications were family history of colon cancer (N=55) and personal history of colon cancer (N=21). Mean age of the cohort was 60.6 years. Approximately half (N=313) of the patients were female. The cohort was 60.5% white, 17% black, 15.9% Hispanic and 4% Asian. Fellows were involved in 54.4% (N=176) of colonoscopies included in this study. For screening colonoscopies, ADR for colonoscopies without a fellow was 26%, which improved to 30.8% with first year fellows, 32.7% with second year fellows, 40.0% with third year fellows (Table 1). For 6 out of 8 attendings, ADR improved with involvement of a fellow.Unadjusted odds ratio for adenoma detection during screening colonoscopy was highest when the attending was accompanied by a third year fellow. The odds ratio was lowest when attendings performed colonoscopy without any fellows on the case. Conclusion: Involvement of a gastroenterology fellow in screening colonoscopies significantly increased ADR, hence improving overall quality of colorectal cancer screening. Further studies are needed to assess other outcomes associated with fellow involvement, such as withdrawal time and duration of anesthesia administration.492_A Figure 1. Proportion of adenoma removal by fellow training year.492_B Figure 2. Unadjusted Odds Ratio associated with adenoma detection rate for the fellow involvement.492_C Figure 3. Comparing adenoma detection rate with and without fellow for each attending.

Adenoma Detection Rate in Colonoscopy: Does the Participation of a Resident Matter?

Presently, endoscopic procedures are a requirement for training competency for completion of a general surgery residency. There are no studies to date that have assessed whether having a resident perform a colonoscopy impacts quality indicators such as adenoma detection rate (ADR). To retrospectively review ADR in adult patients, who undergo screening colonoscopy at a single institution with (ColFacR) and without (ColFac) the participation of a general surgery resident. A total of 792 patients were identified in the database screening colonoscopies between the ages of 45 and 80 from July 2013 to June 2015. Of those, 501 were reviewed after exclusion criteria. When comparing the ColFac group (n = 316) to the ColFacR group (n = 185), there were no differences between age, gender, body mass index, American Society of Anesthesiologists score, or quality of bowel preparation. The mean number of total polyps, hyperplastic polyps, and adenomatous polyps retrieved were similar between the two groups. There was no difference in the ADR for the ColFac cases and ColFacR cases (25.95% vs 27.03%, respectively, P = 0.834). ADR is similar in elective colonoscopies that were performed with or without a general surgery resident. The participation of a general surgery resident in routine colonoscopies should not impact reported quality indicators.

A novel summary report of colonoscopy: timeline visualization providing meaningful colonoscopy video information.

The colonoscopy adenoma detection rate depends largely on physician experience and skill, and overlooked colorectal adenomas could develop into cancer. This study assessed a system that detects polyps and summarizes meaningful information from colonoscopy videos. One hundred thirteen consecutive patients had colonoscopy videos prospectively recorded at the Seoul National University Hospital. Informative video frames were extracted using a MATLAB support vector machine (SVM) model and classified as bleeding, polypectomy, tool, residue, thin wrinkle, folded wrinkle, or common. Thin wrinkle, folded wrinkle, and common frames were reanalyzed using SVM for polyp detection. The SVM model was applied hierarchically for effective classification and optimization of the SVM. The mean classification accuracy according to type was over 93%; sensitivity was over 87%. The mean sensitivity for polyp detection was 82.1%, and the positive predicted value (PPV) was 39.3%. Polyps detected using the system were larger (6.3 ± 6.4 vs. 4.9 ± 2.5mm; P = 0.003) with a more pedunculated morphology (Yamada type III, 10.2 vs. 0%; P < 0.001; Yamada type IV, 2.8 vs. 0%; P < 0.001) than polyps missed by the system. There were no statistically significant differences in polyp distribution or histology between the groups. Informative frames and suspected polyps were presented on a timeline. This summary was evaluated using the system usability scale questionnaire; 89.3% of participants expressed positive opinions. We developed and verified a system to extract meaningful information from colonoscopy videos. Although further improvement and validation of the system is needed, the proposed system is useful for physicians and patients.

大腸内視鏡の腺腫発見率に関する，通常送気化挿入法と無送気浸水法２種類（water exchange法とwater immersion法）の前向き多施設ランダム化比較試験

大腸内視鏡の腺腫発見率に関する，通常送気化挿入法と無送気浸水法２種類（water exchange法とwater immersion法）の前向き多施設ランダム化比較試験

56 Performance of a novel molecular stool screening test, the faecal cologuard® in a cohort of irish symptomatic and surveillance patients

Background Screening tests for precancerous polyps and early CRC reduce mortality. Cologuard is a stool-based, commercially available, molecular screening tool that detects occult blood in combination with multiple DNA abnormalities released from neoplastic colonic cells (from small polyps to cancers). Previous population-based studies reported a sensitivity and specificity of 69%–92% and 87% respectively for detection of polyps. Aim To evaluate the Cologuard in asymptomatic low risk surveillance and symptomatic patients. Method Ethics approval was obtained and patients were recruited from endoscopy referrals and the colonoscopy surveillance waiting list. Inclusion and exclusion criteria in Table 1. Participants provided stool for Cologuard prior to colonoscopy. Cologuard and Colonoscopy results were correlated to calculate NPV, PPV, sensitivity and specificity. Results 60 patients were recruited. To date 40 have completed the study. 22 (55%) female. Median age 60 years (range 42–80). 18 (45%) patients were symptomatic. Colonoscopy adenoma detection rate was 28% (n=11). Cologuard was positive in 10 (25%) patients, 4 of whom had adenomatous polyps, 1>10 mm size and 3 1 cm in size, 1=7 mm and 5 5 mm. No CRC was diagnosed. Conclusions Cologuard seems reliable for excluding CRC and adenomatous polyps>5 mm in size, and maybe useful in triaging surveillance patients for Colonoscopy.

Correlation between adenoma detection rate in colonoscopy- and fecal immunochemical testing-based colorectal cancer screening programs.

The adenoma detection rate (ADR) is the main quality indicator of colonoscopy. The ADR recommended in fecal immunochemical testing (FIT)-based colorectal cancer screening programs is unknown. Using the COLONPREV (NCT00906997) study dataset, we performed a post-hoc analysis to determine if there was a correlation between the ADR in primary and work-up colonoscopy, and the equivalent figure to the minimal 20% ADR recommended. Colonoscopy was performed in 5722 individuals: 5059 as primary strategy and 663 after a positive FIT result (OC-Sensor™; cut-off level 15 µg/g of feces). We developed a predictive model based on a multivariable lineal regression analysis including confounding variables. The median ADR was 31% (range, 14%-51%) in the colonoscopy group and 55% (range, 21%-83%) in the FIT group. There was a positive correlation in the ADR between primary and work-up colonoscopy (Pearson's coefficient 0.716; p < 0.001). ADR in the FIT group was independently related to ADR in the colonoscopy group: regression coefficient for colonoscopy ADR, 0.71 (p = 0.009); sex, 0.09 (p = 0.09); age, 0.3 (p = 0.5); and region 0.00 (p = 0.9). The equivalent figure to the 20% ADR was 45% (95% confidence interval, 35%-56%). ADR in primary and work-up colonoscopy of a FIT-positive result are positively and significantly correlated.

Prospective multicenter randomized controlled trial comparing adenoma detection rate in colonoscopy using water exchange, water immersion, and air insufflation

Adenoma detection rate (ADR), defined as the proportion of patients with at least one adenoma of any size, is a quality indicator. We tested the hypothesis that water exchange (WE) improves ADR but water immersion (WI) has no adverse effect on ADR compared with air insufflation (AI). A prospective study was conducted at the Dalin Tzu Chi Hospital in southern Taiwan and the Hualien Tzu Chi Hospital in eastern Taiwan on patients randomly assigned to WE, WI, or AI with stratification by the 3study colonoscopists. The primary outcome was ADR. From July 2013 to December 2015, 651 patients were recruited and randomized into 3 groups with a 1:1:1 ratio (217 patients per group). Overall, ADR met quality standards: WE 49.8% (95% CI, 43.2%-56.4%), AI 37.8% (95% CI, 31.6%-44.4%), and WI 40.6% (95% CI, 34.2%-47.2%). Compared with AI, WE significantly increased ADR (P= .016). There was no difference between WI and WE. ADRs of WI and AI were comparable. Compared with AI, WE confirmed a longer insertion time, higher cleanliness score, but similar adenoma per positive colonoscopy (APPC) and withdrawal time with polypectomy. Subgroup analysis found WE significantly increased ADR in propofol-sedated patients. Multivariate generalized linear mixed model analysis revealed that age≥50 years, WE (vs AI), colonoscopy indication, no previous history of colonoscopy, and withdrawal time >8 minutes were significant predictors of increased ADR. Confirmation of prior reports showing WE, but not WI, increased ADR further strengthened the validity of our observations. WE significantly increased ADR in propofol-sedated patients. The outcome differences justify assessment of the role of WE in colorectal cancer prevention. Similar APPC and withdrawal times suggest that adequate inspection was performed on colonoscope withdrawal in each of the study arms. (Clinical trial registration number: NCT01894191.).

Adenoma Detection Is Increased in the Setting of Melanosis coli

Introduction: Melanosis coli is a colonoscopic finding in which the colon wall appears darkly pigmented. It is most often a result of extended laxative use, and is considered benign without an association with colorectal cancer or adenomas. The pigmentation typically spares adenomas, which should therefore be more readily detectable in the presence of melanosis. To test this theory, we compared the colonoscopy adenoma detection rate in melanosis coli patients against matched controls.Table 1: Baseline Characteristics of Melanosis Coli Cohort vs. ControlsTable 2: Neoplastic Findings Among Melanosis Coli Cohort vs. ControlsMethods: We identified all patients with melanosis coli on colonoscopy at our institution over a 5-year period. We matched each patient with two non-melanosis coli controls by age, gender, and endoscopist. We compared the prevalence of adenomas between groups, and used the Cochran-Mantel-Haenszel test to determine the association of melanosis coli with adenoma detection by both univariable and multivariable analysis, adjusting for colonoscopy indication and bowel preparation quality. Results: We identified 202 patients with melanosis coli and matched them with 404 controls. The mean age was 61.7 years; 75.2% were female. The indication for colonoscopy in melanosis patients was screening in 37.6% and surveillance in 31.7%; in controls the indication was screening in 41.6% and surveillance in 29%. Bowel preparation was poor in 2.5% of melanosis patients and 4.2% of controls. At least 1 adenoma was detected in 34.7% of melanosis patients vs. 26.5% of controls (OR 1.52; 95% CI 1.04-2.24; p=0.028). On multivariable analysis, melanosis coli remained associated with increased adenoma detection (OR 1.56; 95% CI 1.05-2.33; p=0.029). Melanosis patients were more likely than controls to have an adenoma ≤5mm (OR 1.62; 95% CI 1.04-2.51; p=0.025), but not adenomas 6-9mm (OR 1.36; 95% CI 0.71-2.63; p=0.35) or adenomas ≥10mm (OR 0.71; 95% CI 0.26-1.96, p=0.52). Conclusion: Melanosis coli is associated with a significant increase in the adenoma detection rate during colonoscopy compared to matched controls on both univariable and multivariable analysis; the increased detection is due to lesions ≤5mm. This is the largest study analyzing adenoma prevalence in melanosis compared to matched controls. While it is possible that the increased detection was due to a higher underlying prevalence of adenomas in melanosis, their increased visibility is a likely explanation. Future efforts to identify bowel preparation agents that can safely induce a similar effect could improve the adenoma detection rate of colonoscopy.

Adenoma Detection Rate in a Small Ambulatory Surgery Center

Introduction: Colonoscopy is the most common method to diagnose colon cancer. Colon cancer is the second leading cause of cancer death in our country. The adenoma detection rate has been recommended as one of the main quality indicator. The adenoma detection rate (ADR) is 25%. ADR is 30 % for men and 20% for women. ADR is the quality indicator with the strongest association to post-colonoscopy colorectal cancer or missed colorectal cancer. Improved adenoma detection rate will decrease the incidence of post-colonoscopy colorectal cancer. Newer studies have shown that for each 1% increase in ADR, risk of “missed” CRC decreases by 3%. There are very few studies regarding the adenoma detection rate in Colonoscopy performed in a small ambulatory surgery center. Methods: All patients who underwent screening colonoscopies in our ambulatory surgery center between 2013 to 2015 were included in the data analysis. The ADR is defined as the number of patients out of every 100 undergoing first time screening colonoscopy who have at least one adenoma removed. The withdrawl time was more than 6 minutes in all the screening colonoscopies. The cecal intubation rate was 96.8% in our center. Most of the patient's used split dose colonic prep. The patient's with incomplete colonoscopy secondary to poor prep was excluded from the analysis. Results: There were 4486 procedures performed by two physicians in our ambulatory surgery center. 54.3 % were colonoscopies, 28.8% were upper endoscopies, 0.2 were flexible sigmoidoscopies. 16.6 % were minor surgical procedures like skin abscess drainage, port placement. 616 patient's underwent screening colonoscopies. The mean age of screening colonoscopy group was 58.6 years. Our youngest patient was 50 years old and the oldest was 79 years old. 58.2 % were females and 41.8% were males. 291 patients were found to have adenoma giving adenoma detection rate of 47%. Conclusion: High adenoma detection rate can be achieved in small community ambulatory surgery center provided high quality measures like high cecal intubation rate, good quality prep, increased withdrawl time are achieved diligently. Newer technologies like Fusion scope by Endochoice will also increase the adenoma detection rate. ADR as a quality measure are now being tracked by Medicare and commercial insurance companies. Added pay for performance ADR benchmarks being considered and granted by some commercial payers.

The Goalposts Have Moved: Can Surgery Residents Meet Updated Quality Benchmarks for Adenoma Detection Rate in Colonoscopy?

The American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology Task Force (ACGTF) on Quality in Endoscopy released updated quality benchmarks for colonoscopy in 2015. Our initial study concluded that surgery residents could perform safe and competent screening colonoscopy within a structured endoscopy curriculum. In this follow-up study, we sought to determine whether surgery residents could achieve the increased adenoma detection rate (ADR) benchmarks endorsed by the ASGE/ACGTF. An Institutional Review Board-approved prospective analysis of colonoscopies performed by five postgraduate year 2 and 3 general surgery residents from 2013 to 2015 was completed. All colonoscopies were performed under the direct supervision of surgical endoscopists after each resident passed a structured endoscopy simulation curriculum. The following ASGE/ACG quality metrics were recorded: bowel preparation quality; cecal intubation rate; polyp and ADRs; and, complications. Power analysis determined that 108 procedures were required for an 80 per cent probability of data analysis accuracy. About 135 screening and diagnostic colonoscopies were performed. Bowel prep was considered "adequate" in 90 per cent of cases. The cecum was reached independently in 95 per cent of cases. Polyp(s) were visualized and removed in 39 per cent of patients. The overall ADR was 31.8 per cent (>25%). Male ADR was 38.7 per cent (>30%). Female ADR was 26.0 per cent (>20%). Average polyp size was 8.7 mm (range: 1-22 mm). One patient was readmitted for postpolypectomy syndrome, and successfully managed nonoperatively. In conclusion, using our structured endoscopy curriculum, surgery residents achieved ADRs fully consistent with the updated benchmark values endorsed by the ASGE/ACGTF.