Abstract

BACKGROUND: The adenoma detection rate at screening (ADR) predicts interval colorectal cancer (CRC). Monitoring other lesion detection rates and colonoscopy indications has been proposed. We developed a comprehensive, automated colonoscopy audit program based on standardized clinical documentation, explored detection rates across indications, and developed the "Adenoma Detection Rate - Extended to all Screening / Surveillance" (ADR-ESS) score.METHODS: In a prospective cohort study, we calculated overall and advanced adenoma and sessile serrated lesion (SSL) detection rates among 15,253 colonoscopies by 35 endoscopists from 4 endoscopy units across all colonoscopy indications. We explored correlations between detection rates, and the precision and stability of ADR-ESS vs. ADR.RESULTS: The overall "Screening, first" ADR was 36.3% (95%CI 34.5-38.1%). The adenoma detection rate was lower for "Screening, not first" (RR 0.80 [95%CI 0.74-0.87]) and "Family history" (RR 0.84 [95%CI 0.74-0.96]), and higher for "Surveillance" (RR 1.22 [95%CI 1.15-1.31]) and "Follow-up, FIT" (RR 1.21 [95%CI 1.07-1.37]). For "Screening, first," the detection rates for advanced adenoma, SSL, and advanced SSL were 6.7% (95%CI 5.7-7.7%), 7.2% (95%CI 6.2-8.2%), and 2.6% (95%CI 2.0-3.2%), respectively. Adenoma and SSL detection were correlated (r=0.44, p=0.008). ADR-ESS had substantially narrower confidence intervals and less period-to-period variability than ADR, and was not improved by weighting for indication volume and correction for detection by indication.CONCLUSIONS: Comprehensive, automated colonoscopy audit based on standardized clinical documentation is feasible. Adenoma detection is a fair but imperfect proxy for SSL detection. ADR-ESS increases the precision of adenoma detection assessments and emphasizes quality across colonoscopy indications.

View details for DOI 10.1016/j.cgh.2021.04.027

View details for PubMedID 33895358