Implications of stable or increasing adenoma detection rate on the need for continuous measurement

Measurement of the adenoma detection rate (ADR) is resource intensive, and the benefit of continuous measurement for colonoscopists with high ADR is unclear. We examined the ADR trends at our center to determine whether continuous measurement for consistently high ADR is warranted.

Among colonoscopies performed between January 1999 and November 2019 at a tertiary center, we analyzed data from colonoscopists performing at least 50 screening colonoscopies annually for 5 consecutive years. ADR trends for individual colonoscopists were examined using Joinpoint regression models.

Eleven colonoscopists performed screening colonoscopies on 14,047 patients, and 5912 among them had at least 1 conventional adenoma removed (42.0%). Of 25,829 polyps, 13,585 (52.6%) were conventional adenomas or adenocarcinomas and contributed to ADR calculation. All but 1 colonoscopist included met the recommended minimum threshold ADR of 25% continuously over the study period. Of the 11 colonoscopists, 5 had an increase in their ADR and the remaining 6 had stable ADRs over the study period.

For colonoscopists consistently performing above the minimum threshold, diversion of resources toward improvement of quality measures other than ADR is justified.