Reliability of adenoma detection rate is based on procedural volume

Do, Albert; Weinberg, Janice; Kakkar, Aarti; Jacobson, Brian C.

doi:10.1016/j.gie.2012.10.023

Cited by 86 publications

(45 citation statements)

References 29 publications

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“…In the subanalysis of patients above 50 years of age undergoing first-time colonoscopy, this difference was still present but did not reach statistical significance, which may be due to the small number of patients in this subgroup, as some authors have calculated that a sample size of at least 500 is required to provide a reliable assessment of ADR. 37 These results suggest that patients undergoing screening colonoscopy may not be a homogenous group, just as patients undergoing screening, surveillance, and diagnostic procedures are not homogenous and so their ADRs are not usually pooled. Therefore, variations in ADR between different endoscopists may need to be interpreted with this in mind, given that case mix can vary greatly between endoscopists.…”

Section: Discussionmentioning

confidence: 98%

Adenoma Detection Rate in Colonoscopy

Yang

Wong

2016

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Section: Discussionmentioning

confidence: 98%

Adenoma Detection Rate in Colonoscopy

Yang

Wong

2016

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…The variable gender mix of the various endoscopist’s practices was taken into account by calculating separate male and female ADRs, as well as, a normalized ADR assuming a population that was gender balanced (half male and half female). Confidence intervals were calculated for normalized ADR as recommended by Do et al[23] Comparisons of detection rates for significance were by the Fisher exact test. Logistic regression was performed to assess predictors of ADR and SSA detection using Stata software, version 13.1 (Stata Corp, College Station, TX).…”

Section: Methodsmentioning

confidence: 99%

Detection rates of premalignant polyps during screening colonoscopy: Time to revise quality standards?

Ross

Thirumurthi

Lynch

et al. 2015

Gastrointestinal Endoscopy

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Background Standards for detection of adenomas during screening colonoscopy are widely used to measure examination quality. No such standards exist for sessile serrated adenomas. Objective To measure both the adenoma detection rate (ADR) and sessile serrated adenoma detection rate (SSADR) during screening colonoscopy before and after quality improvement/financial incentive measures. Design Retrospective determination of baseline ADR/SSADR by the endoscopist, followed by prospective collection of data after informing physicians of baseline detection rates. Setting Tertiary cancer center with large cancer screening program. Patients A total of 2833 average-risk colorectal cancer screening patients ages 50 to 75 undergoing initial colonoscopy. Interventions/data collection Electronic medical record for indication and demographics, endoscopy report and pathology report. Main outcome measurements Detection rates of adenomas and sessile serrated adenomas by gender. Results Overall ADR in males and females was 50.6% and 36.6%, respectively. Overall detection of advanced adenomas in males and females was 12.4% and 6.5%, respectively. Overall SSADR in males and females was 10.1% and 7.1%, respectively. In 108 patients (3.8% of entire group) SSAs were the only premalignant lesions found. Detection rates of both types of premalignant polyps improved over time but did not reach statistical significance. Limitations Single-center experience with limited sample size and small group of endoscopists. Conclusions ADRs far in excess of current standards are achievable. Cecal withdrawal time is associated with ADR. Prevalence of SSA rivals that of advanced adenomas and is greater than current medical literature suggests. The combination of monitoring and financial incentives did not result in statistically significant improvement in ADR.

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“…Concerning the latter, several authors have highlighted problems and limitations that pertain to sampling variability and case mix of patients. [36][37][38] Furthermore, the presented approach might be helpful to investigate variability in ADR performance and to determine realistic minimum standards.…”

Section: Discussionmentioning

confidence: 99%

“…Implications of chance variation among ADRs in comparisons of physician performance were investigated in a recent analysis by Do et al 37 The authors found that at least 500 colonoscopies need to be included in the calculation of the ADR to obtain a reliable point estimate that can reasonably been compared. They apply a confidence interval-based approach and suggest minimum numbers of colonoscopies with at least 1 detected adenoma for a given target ADR and colonoscopy volume.…”

Section: Discussionmentioning

confidence: 99%