Adenoma detection rate and the quality of colonoscopy: the sword has two edges

With the increasing demand for colonoscopy for colorectal cancer screening and surveillance of colorectal adenomas and carcinomas, there has been an increasing emphasis on the quality of colonoscopy. Few publications have considered the full implications of pushing the adenoma detection rate as a prime quality indicator. In this article, some of the potential problems with this course are discussed and an alternative approach is suggested. Although defining and measuring quality in colonoscopy is important, further work needs to be done to arrive at a practical, clinically meaningful way of quality assessment.