Prevalence of "one and done" phenomenon in adenoma detection within a large community-based healthcare system

Adenoma detection rate (ADR) is a key quality metric in colonoscopy, reflecting the ability to detect adenomas. However, concerns remain regarding the robustness of ADR as a benchmark. In particular, the "one and done" phenomenon may exist in which physicians are less motivated to find additional adenomas after discovery of the first adenoma. To investigate this topic further, our goal was to understand the relationship between single and multiple adenoma detection.

A retrospective cohort study was conducted by using data from 89,587 screening colonoscopies performed by 32 endoscopists within the Sutter Health-Palo Alto Medical Foundation between 2015 and 2020. ADR, single adenoma detection rate (ADR1), and multiple adenoma detection rate (ADR2+) were analyzed by using multivariate logistic regression and linear regression models. Endoscopists were then fit into 4 categories based on median ADR1 and ADR2+ (low ADR1, high ADR2+ ["all or none"], low ADR1, low ADR2+ ["none and done"], high ADR1, high ADR2+ ["all and done"], or high ADR1, low ADR2+ ["one and done"]).

The overall ADR was 45.4%. ADR, ADR1, and ADR2+ were significantly associated with similar factors, including older age, male sex, higher body mass index, smoking status, high-risk colonoscopies, Medicare insured, use of mucosal assist devices, longer withdrawal times, adequate preparation, and procedures performed by high-volume, female endoscopists with a longer duration in practice. The median ADR1 and ADR2+ were 23.95% and 21.29%, respectively. ADR1 and ADR2+ were positively correlated (Pearson correlation coefficient [r], .701; P < .001). Only 4 of 32 endoscopists fit our "one and done" category.

These findings suggest that ADR1 correlates with ADR2+. Despite concerns, the "one and done" phenomenon is not commonly seen in clinical practice. ADR remains a good surrogate marker for multiple adenoma detection.