From the Guidelines
The goal adenoma detection rate for an individual endoscopist should be ≥30% (aspirational target ≥35%). This is based on the most recent and highest quality study, which suggests that an adenoma detection rate of at least 30% is associated with reduced risk of interval colorectal cancer 1. The adenoma detection rate (ADR) is a key quality indicator for colonoscopy performance, and higher detection rates are associated with better patient outcomes.
Factors Affecting Detection Rates
Several factors can affect detection rates, including:
- Physician technique
- Withdrawal time (ideally 6 minutes or more)
- Bowel preparation quality
- Patient characteristics
Improving Detection Rates
To improve detection rates, endoscopists can consider:
- Extending withdrawal times
- Self-learning regarding mucosal inspection and polyp identification
- Peer feedback
- Other educational interventions
- Using modern technologies like high-definition imaging, narrow-band imaging, and artificial intelligence assistance
Quality Benchmarks
Current quality benchmarks recommend that physicians should detect adenomas in at least 30% of screening colonoscopies, with an aspirational target of 35% 1. Regular monitoring of detection rates is considered a key quality indicator for colonoscopy performance, with higher rates indicating more thorough examinations and better cancer prevention.
Importance of Detection Rates
Detection rates are important because they are associated with reduced risk of interval colorectal cancer. A study found that improvements in ADR are associated with a reduced interval CRC risk, and that an ADR of roughly 35% or higher is associated with further reduced risk of interval CRC 1.
From the Research
Colonoscopy Polyp Detection Rate
The colonoscopy polyp detection rate, also known as the adenoma detection rate (ADR), is a measure of the quality of colonoscopy procedures. According to 2, the overall ADR was 37%, with proximal ADR at 28% and distal ADR at 17%.
Factors Affecting Polyp Detection Rate
Several factors can affect the polyp detection rate, including:
- Quality of bowel preparation: Adequate bowel preparation is essential for thorough visualization of the colon and detection of polyps 3.
- Endoscopist technique: A good endoscopic technique and optimal withdrawal time can optimize the rate of cecal intubation and the number of lesions detected 4.
- Use of adjunctive tools: Adjunctive tools such as double right colon examination, patient position change, water exchange, mucosal exposure devices, and lesion highlighting techniques can improve ADR 5.
- Indication for colonoscopy: The prevalence of polyps and adenomas differs based on colonoscopy indication, with adenoma detection being highest in surveillance and more commonly detected in the proximal colon 2.
Targets for Polyp Detection Rate
Distinct ADR and polyp detection rate (PDR) targets may need to be established for different colonoscopy indications 2. For example, the suggested level of ADR is greater than 25% in men and 15% in women 4.
Optimization of Adenoma Detection Rate
Several strategies can be used to optimize ADR, including:
- Improving quality of precolonoscopy preparation
- Using additional observers or manoeuvres with the endoscope
- Increasing time spent during withdrawal
- Changing patient position
- Using fold-flattener devices or new imaging or endoscopic modalities
- Using intravenous or through the scope sprayed drugs 6.