Adenoma Detection Rate Benchmarks: An Updated Analysis

Early-onset colorectal cancer prompted organizations to reduce the recommended screening initiation age from 50 to 45 years. The American Society for Gastrointestinal Endoscopy Quality Assurance in Endoscopy Committee recommends 3 priority quality indicators for colonoscopy services. The adenoma detection rate is considered the most important measure with the established benchmark based upon studies of patients 50 years or older. The incidence of polyps increases with age, so this change has an as-yet-unknown effect on the new benchmark. Five studies were reviewed. Based upon the results, 45- to 50-year-old patients should be included in facilities' adenoma detection rate calculations using the currently recommended benchmarks of 25% for women and men combined, or 20% for women and 30% for men when the genders are calculated separately. Males consistently had more adenomas than females in each of the 3 studies that separated genders, a detail that might merit gender-based adenoma detection rate determinations in some practices. One study indicated caution is advised; it recommends males and females be calculated separately and different benchmarks be used for each gender. The adenoma detection rate has been shown to increase over time. More studies are needed to guide screening quality metrics.