Traditional and Novel Colonoscopy Quality Metrics: What's Important in 2025

Area of Science:

• Gastroenterology
• Endoscopy
• Colorectal Cancer Prevention

Background:

• Colonoscopy quality metrics are essential for ensuring effective colorectal cancer screening and prevention.
• Traditional metrics like adenoma detection rate (ADR) and cecal intubation rate (CIR) have long been the standard.
• Recent guidelines introduce new, more granular metrics focused on lesion detection.

Purpose of the Study:

• To review the current landscape of colonoscopy quality metrics, focusing on intraprocedural indicators.
• To clarify the rationale, evidence, and implementation of traditional and new metrics.
• To highlight metrics most relevant for improving patient outcomes by 2025.

Main Methods:

• Review of current literature and guidelines on colonoscopy quality metrics.
• Analysis of traditional and newly introduced quality indicators.
• Emphasis on intraprocedural measures and their impact on patient outcomes.

Main Results:

• 2024 guidelines reaffirm ADR, CIR, bowel preparation, and surveillance intervals.
• New metrics include sessile serrated lesion detection rate (SSLDR), adenomas per colonoscopy (APC), and extended withdrawal time.
• Traditional metrics are feasible and linked to reduced post-colonoscopy colorectal cancer (PCCRC).
• New detection-focused metrics (SSLDR, APC) independently lower PCCRC but face adoption challenges.

Conclusions:

• A strong foundation in traditional colonoscopy quality metrics is vital.
• Systems should be developed to monitor novel metrics like SSLDR and APC.
• Continuous quality measurement, automated or manual, is key to high-quality, cancer-preventing colonoscopy.