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Endoscopy 2025; 57(01): 49-61
DOI: 10.1055/a-2382-5795
Systematic review

Adenoma detection rate by colonoscopy in real-world population-based studies: a systematic review and meta-analysis

Carlos Fernandes
1   Programme in Health Data Science, University of Porto Faculty of Medicine, Porto, Portugal (Ringgold ID: RIN26705)
,
Manuela Estevinho 
2   Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, Vila Nova de Gaia, Portugal (Ringgold ID: RIN59043)
3   Department of Biomedicine, Unit of Pharmacology and Therapeutics, University of Porto Faculty of Medicine, Porto, Portugal (Ringgold ID: RIN26705)
,
Manuel Marques Cruz
4   MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, University of Porto Faculty of Medicine, Porto, Portugal (Ringgold ID: RIN26705)
5   CINTESIS@RISE, MEDCIDS, University of Porto Faculty of Medicine, Porto, Portugal (Ringgold ID: RIN26705)
,
Leonardo Frazzoni 
6   Gastroenterology and Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, Italy
,
Pedro Pereira Rodrigues
5   CINTESIS@RISE, MEDCIDS, University of Porto Faculty of Medicine, Porto, Portugal (Ringgold ID: RIN26705)
,
Lorenzo Fuccio  ‡
7   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)
8   Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
,
Mário Dinis-Ribeiro‡
9   Gastroenterology Department and PreCAM, RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
10   Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal
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Author commentary on Carlos Fernandes et al.Endoscopy 2025; 57(01): v3-v3
DOI: 10.1055/a-2381-7937

Abstract

Background Adenoma detection rate (ADR) is a quality indicator set at a minimum of 25% in unselected populations by the European Society of Gastrointestinal Endoscopy (ESGE). Nevertheless, a lack of pooled observational data resembling real-world practice limits support for this threshold. We aimed to perform a systematic review with meta-analysis to evaluate the pooled rates for conventional adenoma detection, polyp detection (PDR), cecal intubation, bowel preparation, and complications in population-based studies.

Methods The PubMed, Scopus, and Web of Science databases were searched until May 2023 for populational-based studies reporting overall ADR in unselected individuals. A random-effects model was used for meta-analysis.

Results 31 studies were included, comprising 3 644 561 subjects. A high quality of procedures was noticeable, with a high cecal intubation rate and low complication rate. The overall pooled ADR, PDR, and rate of cancer detection were 26.5% (95%CI 23.3% to 29.7%), 38.3% (95%CI 32.5% to 44.1%), and 2.7% (95%CI 1.5% to 3.9%), respectively. ADR varied according to indication: screening 33.3% (95%CI 24.5% to 42.2%), surveillance 42.9% (95%CI 36.9% to 49.0%), and diagnostic 24.7% (95%CI 19.5% to 29.9%), with subgroup analysis revealing rates of 34.4% (95%CI 22.0% to 40.5%) for post-fecal occult blood test and 26.6% (95%CI 22.6% to 30.5%) for primary colonoscopy screening. Diminutive conventional adenomas yielded a pooled rate of 59.9% (95%CI 43.4% to 76.3%). The pooled rate for overall serrated lesion detection was 12.4% (95%CI 8.8% to 16.0%). Male sex and higher age were significantly associated with an ADR above the benchmark.

Conclusion This first meta-analysis relying on real-world observational studies supports the ESGE benchmark for ADR, while suggesting that different benchmarks might be used according to indication, sex, and age.

Supplementary Material



Publication History

Received: 15 January 2024

Accepted after revision: 04 July 2024

Article published online:
03 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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