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DOI: 10.1055/s-0043-113445
Calculating the adenoma detection rate in screening colonoscopies only: Is it necessary? Can it be gamed?
Publikationsverlauf
submitted 21. November 2016
accepted after revision 21. Mai 2017
Publikationsdatum:
28. Juli 2017 (online)
![](https://www.thieme-connect.de/media/endoscopy/201711/lookinside/thumbnails/15142_10-1055-s-0043-113445-1.jpg)
Abstract
Background Current recommendations are to calculate the adenoma detection rate (ADR) in screening colonoscopies only. The need to confine the measure to screening has not been established.
Methods We retrospectively assessed our quality database for whether calculating ADR from screening, surveillance, and diagnostic colonoscopies (overall ADR) would alter conclusions about the performance of colonoscopists, compared to using an ADR based only on screening colonoscopies. We also prospectively tested the extent to which one physician could corrupt the screening-only ADR by changing the procedure indication after reviewing the examination findings.
Results For 15 physicians, screening ADRs differed from the overall ADR by a mean of 2.6 percentage points (range 0 – 6.9 percentage points). Using the overall ADR rather than screening ADR changed the ADR from just below to just above the recommended screening threshold for one physician. In the prospective assessment, a single expert colonoscopist utilized indication gaming in patients with both screening and diagnostic indications and was able to increase his apparent screening-only ADR from 48.4 % to 55.1 %.
Conclusions Use of an overall ADR rather than screening-only ADR could simplify ADR measurement, increase the number of examinations available to measure ADR, seldom affect whether a doctor meets recommended ADR thresholds, and eliminate the potential for gaming the ADR by changing the colonoscopy indication.
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References
- 1 Rex DK, Petrini JL, Baron TH. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2006; 63: S16-28
- 2 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Am J Gastroenterol 2015; 110: 72-90
- 3 Rex DK, Bond JH, Winawer S. et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2002; 97: 1296-1308
- 4 Rex DK, Lehman GA, Ulbright TM. et al. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history. Am J Gastroenterol 1993; 88: 825-831
- 5 Schoenfeld P, Cash B, Flood A. et al. Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med 2005; 352: 2061-2068
- 6 Lieberman DA, Weiss DG, Bond JH. et al. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med 2000; 343: 162-168
- 7 Imperiale TF, Wagner DR, Lin CY. et al. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 2000; 343: 169-174
- 8 Denis B, Sauleau EA, Gendre I. et al. The mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy: a population-based cohort study. Dig Liver Dis 2014; 46: 176-181
- 9 Wang HS, Pisegna J, Modi R. et al. Adenoma detection rate is necessary but insufficient for distinguishing high versus low endoscopist performance. Gastrointest Endosc 2013; 77: 71-78
- 10 Barclay RL, Vicari JJ, Doughty AS. et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006; 355: 2533-2541
- 11 Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol 2007; 102: 856-861
- 12 Kahi CJ, Vemulapalli KC, Johnson CS. et al. Improving measurement of the adenoma detection rate and adenoma per colonoscopy quality metric: the Indiana University experience. Gastrointest Endosc 2014; 79: 448-454
- 13 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
- 14 Corley D, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 1298-1306
- 15 Hewett DG, Kaltenbach T, Sano Y. et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 2012; 143: 599-607 e1
- 16 Rex DK. Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology 2009; 136: 1174-1181
- 17 Hewett DG, Huffman ME, Rex DK. Leaving distal colorectal hyperplastic polyps in place can be achieved with high accuracy by using narrow-band imaging: an observational study. Gastrointest Endosc 2012; 76: 374-380
- 18 Anderson JC, Butterly LF, Goodrich M. et al. Differences in detection rates of adenomas and serrated lesions in screening vs surveillance colonoscopies. Clin Gastroenterol Hepatol 2013; 11: 1308-1312