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Related Concept Videos

Assessment of the Rectum and Anus01:25

Assessment of the Rectum and Anus

Evaluating the rectum and anus plays a crucial role in conducting a thorough physical examination of the gastrointestinal system. Although it may be uncomfortable and often embarrassing for the patient, it holds immense diagnostic value, particularly in detecting gastrointestinal diseases and abnormalities. This guide will explain how to perform this assessment using inspection and palpation methods.
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Endoscopic Procedures II: Colonoscopy01:25

Endoscopic Procedures II: Colonoscopy

The colon, or large intestine, is the final segment of the digestive system. Its primary functions include absorbing water and vitamins produced by gut bacteria and transforming waste from liquid to solid to form stool. In adults, the large intestine is approximately 5 feet long and consists of four main sections:

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Adenoma Detection Rates Calculated Using All Examinations Are Associated With Lower Risk for Postcolonoscopy

Joseph C Anderson1,2, Douglas K Rex3, Todd A Mackenzie1

  • 1Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.

The American Journal of Gastroenterology
|April 11, 2025
PubMed
Summary
This summary is machine-generated.

Higher adenoma detection rates (ADR) calculated using all colonoscopy examinations significantly reduce postcolonoscopy colorectal cancer (PCCRC) risk. Aiming for an ADR of 44% is a key quality benchmark for improved patient outcomes.

Keywords:
adenomascolonoscopydetectionmetrics

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Area of Science:

  • Gastroenterology
  • Oncology
  • Public Health

Background:

  • Postcolonoscopy colorectal cancer (PCCRC) remains a concern, necessitating robust quality metrics for colonoscopy.
  • Adenoma detection rate (ADR) is a key performance indicator, but its calculation method (all examinations vs. screening only) may influence its association with PCCRC risk.

Purpose of the Study:

  • To investigate the association between PCCRC risk and endoscopist-specific ADR calculated using all colonoscopy indications (ADR-A).
  • To compare the performance of ADR-A with ADR calculated using only screening examinations (ADR-S) as a quality measure.

Main Methods:

  • A cohort study utilized data from the New Hampshire Colonoscopy Registry.
  • Included patients with an index colonoscopy and subsequent follow-up (colonoscopy or CRC diagnosis).
  • Cox regression modeled PCCRC hazard based on ADR-A quintiles, controlling for covariates.

Main Results:

  • A lower hazard for PCCRC was observed with higher ADR-A (≥23%).
  • Endoscopists in the highest ADR-A quartile (≥44%) showed significantly reduced PCCRC risk (HR=0.32).
  • ADR-A demonstrated narrower confidence intervals, suggesting increased precision compared to ADR-S.

Conclusions:

  • Higher ADR-A is associated with a lower risk of PCCRC, validating ADR-A as a quality measure.
  • ADR-A may offer improved precision in assessing endoscopist performance.
  • An ADR-A of 44% is proposed as an aspirational target for endoscopists.