Adenoma detection rate as a quality indicator in diagnostic colonoscopy among symptomatic patients: a single-centre study

Colorectal cancer (CRC) remains a major health concern. Adenoma Detection Rate (ADR) is a key quality indicator in colonoscopy and has been primarily studied in screening populations.  Objectives: To report the ADR among symptomatic patients aged ≥50 years undergoing diagnostic colono-scopy, determine the overall adenoma prevalence, and describe the characteristics and associations of adenomatous polyps.

Data from 235 consecutive symptomatic patients undergoing colonoscopy by a single endoscopist at a single centre over three years were analysed retrospectively. Demographic information, endoscopic findings and histopathological reports were collected. The chi-square and Fisher's exact test were used to compare the adenoma prevalence across the different age groups and genders, taking a p-value of 0.05 as statistically significant.

The majority of patients were males (56%), with a median age of 60 years (IQR:42-69). The ADR among symptomatic patients aged ≥50 years was 22% (95%CI:16.2-27.7), while the overall adenoma prevalence was 19.6% (95%CI:14.9-25.1). Polyps and histologically confirmed malignancies were detected in 52 patients (22.1%), with 46 (19.6%) having adenomas. Most adenomas were sessile (77%, n=57) and located in the descending or sigmoid (39.2%) and transverse colon (35.1%). Multiple adenomas were detected in 34.8%. There was an age-related rise in adenoma prevalence, with those aged ≥60 years having the highest ADR (25.4%, p<0.05).  Conclusion: The observed ADR of 22% in patients aged ≥50 years serves as preliminary evidence for a regional ADR benchmark for diagnostic colonoscopy in symptomatic patients, outside of screening programmes, particularly in resource-limited settings.