Related Experiment Video
Updated: Apr 3, 2026
DIPLOMA Approach for Standardized Pathology Assessment of Distal Pancreatectomy Specimens
Published on: February 1, 2020
The impact of exclusion criteria on a physician's adenoma detection rate
Felippe O Marcondes1, Katie M Dean2, Robert E Schoen3
1The University of Texas Medical Branch at Galveston, Galveston, Texas.
Background:
The adenoma detection rate (ADR) is a validated and widely used measure of colonoscopy quality. There is uncertainty in the published literature as to which colonoscopy examinations should be excluded when measuring a physician's ADR.
Objective:
To examine the impact of varying the colonoscopy exclusion criteria on physician ADR.
Design:
We applied different exclusion criteria used in 30 previous studies to a dataset of endoscopy and pathology reports. Under each exclusion criterion, we calculated physician ADR.
Setting:
A private practice colonoscopy center affiliated with the University of Illinois College of Medicine.
Patients:
Data on 20,040 colonoscopy examinations performed by 11 gastroenterologists from July 2009 to May 2013 and associated pathology notes.
Main Outcome Measurements:
ADRs across all colonoscopy examinations, each physician's ADR, and ADR ranking.
Results:
There were 28 different exclusion criteria used when measuring the ADR. Each study used a different combination of these exclusion criteria. The proportion of all colonoscopy examinations in the dataset excluded under these combinations of exclusion criteria ranged from 0% to 92.2%. The mean ADR across all colonoscopy examinations was 39.1%. The change in mean ADR after applying the 28 exclusion criteria ranged from -5.5 to +3.0 percentage points. However, the exclusion criteria affected each physician's ADR relatively equally, and therefore physicians' rankings via the ADR were stable.
Limitations:
ADR assessment was limited to a single private endoscopy center.
Conclusion:
There is wide variation in the exclusion criteria used when measuring the ADR. Although these exclusion criteria can affect overall ADRs, the relative rankings of physicians by ADR were stable. A consensus definition of which exclusion criteria are applied when measuring ADR is needed.
