Adenoma Detection Rate: I Will Show You Mine if You Show Me Yours

Abstract

Background: Colorectal cancer (CRC) is the first cause of cancer-related mortality in Portugal. CRC screening reduces disease-specific mortality. Colonoscopy is currently the preferred method for screening as it may contribute to the reduction of CRC incidence. This beneficial effect is strongly associated with the adenoma detection rate (ADR). Aim: Our aim was to evaluate the quality of colonoscopy at our unit by measuring the currently accepted quality parameters and publish them as benchmarking indicators. Methods: From 5,860 colonoscopies, 654 screening procedures (with and without previous fecal occult blood testing) were analyzed. Results: The mean age of the patients was 66.4 ± 7.8 years, and the gender distribution was 1:1. The overall ADR was 36% (95% confidence interval [CI] 32-39), the mean number of adenomas per colonoscopy was 0.66 (95% CI 0.56-0.77), and the sessile serrate lesion detection rate was 1% (95% CI 0-2). The bowel preparation was rated as adequate in 496 (76%) patients. The adjusted cecal intubation rate (CIR) was 93.7% (95% CI 91.7-95.8). Most colonoscopies were performed under monitored anesthesia care (53%), and 35% were unsedated. The use of sedation (propofol or midazolam based) was associated with a higher CIR with an odds ratio of 3.60 (95% CI 2.02-6.40, p < 0.001). Conclusion: Our data show an above-standard ADR. The frequency of poor bowel preparation and the low sessile serrated lesion detection rate were acknowledged, and actions were implemented to improve both indicators. Quality auditing in colonoscopy should be compulsory, and while many units may do so internally, this is the first national report from a high-throughput endoscopy unit.

The yield of fecal occult blood testing as a screening tool for colon cancer in a primary care setting

“…[ 17 ] Figure 3 illustrates the comparison between the ADR in our study and the ADR from other studies undertaken within our region and worldwide. [ 16 17 18 19 20 21 22 ] The ADR in our study was 34%, which is considered to be above the standard. The ADR reported in a study conducted in Portugal was also found to be above the standard ADR; it was slightly higher than the 34% ADR found in our study.…”

“…The ADR reported in a study conducted in Portugal was also found to be above the standard ADR; it was slightly higher than the 34% ADR found in our study. [ 18 ] One reason that might explain a higher-than-expected ADR in our study is the patient population that underwent colonoscopy. The majority of colonoscopies were performed on FOBT-positive patients; 52% of FOBT-positive patients underwent colonoscopy, whereas only 9.8% of FOBT-negative patients proceeded to colonoscopy.…”

“… Comparison of Adenoma Detection Rate percentage reported in different countries[ 16 17 18 19 20 21 22 ] …”

Endocuff-Assisted Colonoscopy Does Not increase the Sessile Serrated Lesion Detection Rate – A Randomized Controlled Trial

“…We accounted for a 2% crossover rate and therefore adjusted the sample size to 216 colonoscopies. Furthermore, based on data from our institution, we anticipated that more than 80% of patients would have adequate bowel preparation according to the validated Boston Bowel Preparation Scale (BBPS) [32]. To compensate for poor mucosal visualization and lower lesion detection due to poor preparation, we further adjusted the sample size to 254 patients.…”

Adenoma Detection Rate: Quality Indicators for Colonoscopy

“…In this issue, a retrospective study by Oliveira Ferreira et al [16] entitled "Adenoma Detection Rate: I Will Show You Mine If You Show Me Yours" is published. The authors retrospectively analyzed the colonoscopy quality of their endoscopy unit, which included 654 screening procedures from a total of 5,860 colonoscopies performed in 3 years.…”