Implementing key quality performance metrics improves colorectal adenoma detection: Evidence from India

Area of Science:

• Gastroenterology and Endoscopy
• Public Health and Epidemiology
• Cancer Research

Background:

• Colorectal cancer (CRC) incidence is rising in India, a nation with limited formal screening programs.
• Perceived low adenoma prevalence is a barrier to CRC screening program implementation.
• This study addresses the need to evaluate adenoma detection rates (ADR) in the Indian context.

Purpose of the Study:

• To assess the impact of quality improvement measures on ADR in India.
• To identify factors associated with adenoma detection during colonoscopy.
• To provide insights for developing effective CRC screening strategies in India.

Main Methods:

• A single-center study included consecutive patients aged 18 years and above undergoing colonoscopy.
• A retrospective control arm (Sept 2022-Aug 2023) was compared with a prospective intervention arm (Sept 2023-Aug 2024).
• The intervention arm implemented standardized, quality-focused withdrawal techniques during colonoscopy.

Main Results:

• The intervention arm demonstrated significantly higher polyp detection rates (32.7% vs. 11.0%) and ADR (20.5% vs. 6.3%) compared to the control arm (p < 0.0001).
• ADR increased with age, with rates of 11.1% (<45 years), 27.9% (≥45 years), and 36.2% (>60 years).
• Independent predictors of adenoma detection included quality improvement measures (OR 3.3), age ≥45 years (OR 3.0), male sex (OR 1.6), and withdrawal time ≥6 min (OR 1.8).

Conclusions:

• Implementing quality improvement measures and standardized withdrawal techniques significantly enhanced ADR in Indian clinical practice.
• These findings advocate for adopting quality-focused colonoscopy practices to improve CRC detection.
• The study provides crucial epidemiological data to inform CRC screening strategies in developing nations like India.