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. 2014 Mar;79(3):448-54.
doi: 10.1016/j.gie.2013.10.013. Epub 2013 Nov 15.

Improving Measurement of the Adenoma Detection Rate and Adenoma Per Colonoscopy Quality Metric: The Indiana University Experience

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Improving Measurement of the Adenoma Detection Rate and Adenoma Per Colonoscopy Quality Metric: The Indiana University Experience

Charles J Kahi et al. Gastrointest Endosc. .

Abstract

Background: The adenoma detection rate (ADR) is a validated marker of colonoscopy quality. However, the optimal measurement method is unclear.

Objective: The aims of our study were to (1) define benchmarks for the number of adenomas per screening colonoscopy (APC) quality metric; (2) study the association between ADRs for screening, surveillance, and diagnostic indications; and (3) explore the association of the screening ADR with an overall ADR inclusive of all colonoscopy indications.

Design: Retrospective study.

Setting: University hospital and associated ambulatory surgery center endoscopy units.

Patients: Patients aged ≥50 years who underwent colonoscopy for screening, surveillance, or diagnostic indications by 20 endoscopists between January 1, 1999 and April 30, 2012.

Intervention: Colonoscopy.

Main outcome measurements: ADR, APC for screening, surveillance, and diagnostic indications.

Results: A total of 21,766 colonoscopies were included. The indication was screening in 7434 (34.2%), surveillance in 8338 (38.3%), and diagnostic in 5994 (27.5%). The screening ADRs and APCs were significantly correlated (R = 0.91; P < .0001). For men, an ADR of 25% corresponded to an APC of 0.46 (95% confidence interval [CI], 0.35-0.57); for women, an ADR of 15% corresponded to an APC of 0.20 (95% CI, 0.13-0.27). Overall, the ADR stratified by colonoscopy indication was highest for surveillance, followed by screening, then diagnostic. For men, a screening ADR of 25% corresponded to a surveillance ADR of 31.9% (95% CI, 24.8%-38.9%); for women, an ADR of 15% corresponded to a surveillance ADR of 24.3% (95% CI, 18.3%-30.5%). The corresponding diagnostic ADRs were 17.0% (95% CI, 12.4%-21.6%) and 15.4% (95% CI, 11.5%-19.3%), respectively. There was significant correlation between screening ADR and an overall ADR inclusive of all colonoscopy indications.

Limitations: External generalizability, retrospective design.

Conclusion: We propose minimum screening APC detection benchmarks of 0.50 for men and 0.20 for women. ADRs for screening, surveillance, and diagnostic colonoscopy are correlated and can be used to derive a simplified overall ADR inclusive of all colonoscopy indications.

Comment in

  • Set higher adenomas per colonoscopy benchmark.
    Kumar AR. Kumar AR. Gastrointest Endosc. 2014 Sep;80(3):539-41. doi: 10.1016/j.gie.2014.04.003. Gastrointest Endosc. 2014. PMID: 25127957 No abstract available.
  • Response:
    Kahi CJ, Eckert GJ, Vemulapalli K, Rex DK. Kahi CJ, et al. Gastrointest Endosc. 2014 Sep;80(3):541. doi: 10.1016/j.gie.2014.04.044. Gastrointest Endosc. 2014. PMID: 25127958 No abstract available.

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