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

Colorectal cancer (CRC) incidence is rising in India, yet formal screening programs are lacking, in part due to the perceived low adenoma prevalence. This study aimed at evaluating the impact of quality improvement measures on adenoma detection rate (ADR) in a real world Indian setting and identifying factors associated with adenoma detection.

In this single-center study, consecutive patients aged ≥ 18 years undergoing colonoscopy between September 2022 and August 2024 were included. Colonoscopy data from September 2022 to August 2023 served as a retrospective control arm, while those from September 2023 to August 2024 formed the prospective intervention arm, following implementation of standardized quality-focused withdrawal techniques.

Of 2260 patients (mean age 47.3 ± 13.8 years, 69% male), 1265 were in the intervention arm. The intervention arm showed significantly higher polyp detection rates (32.7% vs. 11.0%) and ADR (20.5% vs. 6.3%) compared to controls (p < 0.0001), with no difference in CRC detection (1.8% vs. 2.3%, p = 0.48). ADR increased with age: 11.1% in < 45 years, 27.9% in ≥ 45 years and 36.2% in > 60 years. Independent predictors of adenoma detection included implementation of 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) (all p < 0.0001).

Implementation of quality improvement measures and standardized withdrawal techniques significantly improved ADR in an Indian clinical practice setting. These findings support the adoption of quality-focused practices and provide epidemiological insights relevant to CRC screening strategies in developing countries like India.