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Proposal of high-risk adenoma detection rate as an impactful, complementary quality indicator of colonoscopy

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Abstract

Background and aims

Adenoma detection rate (ADR), a validated quality indicator (QI) of colonoscopy, does not take into account risk stratification of adenomas. Low-risk adenomas are not associated with a significantly increased risk of future colorectal cancer (CRC). On the other hand, high-risk adenomas (HRA) are associated with up to six fold higher risk of future CRC. Therefore, HRA detection rate (HR-ADR) as a QI in addition to ADR may further enhance the efficacy of screening colonoscopy. Our aim was to calculate ADR and HR-ADR in a large cohort of average risk screening colonoscopy patients and propose HR-ADR which correlates with current threshold ADR.

Methods

This is a retrospective chart review of all colonoscopies performed in patients aged ≥ 50 years at our institution between 2012 and 2014. Average risk patients who had complete colonoscopy with good, excellent and adequate bowel preparation were included. Overall and gender-specific ADR and HR-ADR were calculated. HR-ADR was defined as proportion of colonoscopies with HRA.

Results

Among 4158 colonoscopies included, ADR was 26.4 ± 10.9% overall, 32.7 ± 14.5% in men, and 22.1 ± 12.6% in women. HR-ADR was 8.0 ± 5.7% overall, 10.2 ± 8.6% in men, and 6.1 ± 6% in women. There was only moderate correlation between ADR and HR-ADR [r = 0.57 (0.40–0.70)]. HR-ADR corresponding with minimum threshold ADR of 30% in men and 20% in women were calculated to be 7% in men and 4% in women.

Conclusions

HR-ADR correlates only moderately with ADR. Based on the current threshold ADRs, we propose a benchmark HR-ADR of 7% in men and 4% in women as complementary QI to ADR.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA

    Vaibhav Wadhwa

  2. Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Cleveland, OH, USA

    Yash Jobanputra, Haider Al Taii, Prashanthi N. Thota & Madhusudhan R. Sanaka

  3. Department of Biostatistics and Quantitative Health Sciences, Cleveland Clinic Florida, Cleveland, OH, USA

    Rocio Lopez

  4. Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA

    Suryakanth R. Gurudu

  5. Center for Advanced Endoscopy, Desk Q3, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44106, USA

    Madhusudhan R. Sanaka

Authors
  1. Vaibhav Wadhwa
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  2. Yash Jobanputra
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Contributions

VW—study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript; YJ—analysis and interpretation of data, drafting of the manuscript; HAT—study concept and design, drafting of the manuscript; RL—statistical analysis and interpretation of data; PNT—drafting of the manuscript and critical revision of the manuscript; SRG—drafting of the manuscript and critical revision of the manuscript; MRS—study concept and design, interpretation of data, critical revision, study supervision and final approval of the manuscript.

Corresponding author

Correspondence to Madhusudhan R. Sanaka.

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Disclosures

Vaibhav Wadhwa, Yash Jobanputra, Haider Al Taii, Prashanthi N. Thota, Rocio Lopez, Suryakanth R. Gurudu, and Madhusudhan R. Sanaka have no conflicts of interest or financial ties to disclose.

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Wadhwa, V., Jobanputra, Y., Al Taii, H. et al. Proposal of high-risk adenoma detection rate as an impactful, complementary quality indicator of colonoscopy. Surg Endosc 34, 325–331 (2020). https://doi.org/10.1007/s00464-019-06770-6

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  • DOI: https://doi.org/10.1007/s00464-019-06770-6

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