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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(11): E1560-E1565
DOI: 10.1055/a-1261-9074
Original article

Adenomas per colonoscopy and adenoma per positive participant as quality indicators for screening colonoscopy

Shuo Wang
1   Division of Epidemiology & Community Health, School of Public health, University of Minnesota, Minneapolis, Minnesota, United States
,
Adam S. Kim
2   Minnesota Gastroenterology PA – GI, Minneapolis, Minnesota, United States
,
Timothy R. Church
3   Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States
,
David G. Perdue
2   Minnesota Gastroenterology PA – GI, Minneapolis, Minnesota, United States
,
Aasma Shaukat
3   Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States
4   Department of Medicine, School of Medicine, University of Minnesota, Minneapolis, Minnesota, United States
5   Division of Gastroenterology, Minneapolis VA Medical Center, Minneapolis, Minnesota, United States
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Abstract

Background and study aims Adenomas per colonoscopy (APC) and adenomas per positive patient (APP) have been proposed as additional quality indicators but their association with adenoma detection rate (ADR) is not well studied. The aim of our study was to evaluate the variability in APC and APP, their association with ADR, and associated risk factors in screening colonoscopies from a community practice.

Patients and methods We calculated the APC, APP, and ADR from all screening colonoscopies performed over 5 years. We used adjusted hierarchical logistic regression to assess the association of factors with APC, APP, and ADR.

Results There were 80,915 screening colonoscopies by 60 gastroenterologists. The median (Q1-Q3) APC, APP, and ADR were 0.41 (0.36 – 0.53), 1.33 (1.23 – 1.40), and 0.32 (0.28 – 0.38), respectively. Despite the high correlation between APC and ADR, 47.6 % of endoscopists with the lowest APC had a higher ADR, and no endoscopists with the highest APC had a lower ADR. Of endoscopists with the lowest APP, 74.3 % had a higher ADR and 5.6 % of endoscopists with the highest APP had a lower ADR. Factors associated with higher APC after multivariable adjustment included: older patients age (OR 1.003; 95 % CI 1.002 – 1.005), male patients (OR 1.123; 95 % CI 1.090 – 1.156), younger endoscopist age (OR 0.943; 95 % CI 0.941 – 0.945), and longer withdrawal time (OR 3.434; 95 % CI 2.941 – 4.010). Factors associated with higher APP were male sex, younger endoscopist age, and longer withdrawal time.

Conclusion APC and APP provides additional information about endoscopist performance. Younger endoscopist age and longer withdrawal time are associated with colonoscopy quality.



Publication History

Received: 19 March 2020

Accepted: 30 July 2020

Article published online:
22 October 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Jang JY, Chun HJ. Bowel preparations as quality indicators for colonoscopy. World J Gastroenterol 2014; 20: 2746-2750
    CrossrefPubMedGoogle Scholar
  • 2 Winawer SJ, Zauber AG, Ho MN. et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329: 1977-1981
    CrossrefPubMedGoogle Scholar
  • 3 Jrebi NY, Hefty M, Jalouta T. et al. High-definition colonoscopy increases adenoma detection rate. Surg Endosc 2017; 31: 78-84
    CrossrefPubMedGoogle Scholar
  • 4 Corley DA, Levin TR, Doubeni CA. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 2541
    CrossrefPubMedGoogle Scholar
  • 5 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
    CrossrefPubMedGoogle Scholar
  • 6 Kaminski MF, Wieszczy P, Rupinski M. et al. Increased rate of adenoma detection associates with reduced risk of colorectal cancer and death. Gastroenterology 2017; 153: 98-105
    CrossrefPubMedGoogle Scholar
  • 7 Shaukat A, Oancea C, Bond JH. et al. Variation in detection of adenomas and polyps by colonoscopy and change over time with a performance improvement program. Clin Gastroenterol Hepatol 2009; 7: 1335-1340
    CrossrefPubMedGoogle Scholar
  • 8 Aniwan S, Orkoonsawat P, Viriyautsahakul V. et al. The secondary quality indicator to improve prediction of adenoma miss rate apart from adenoma detection rate. Am J Gastroenterol 2016; 111: 723-729
    CrossrefPubMedGoogle Scholar
  • 9 Zhao S, Wang S, Pan P. et al. Magnitude, risk factors, and factors associated with adenoma miss rate of tandem colonoscopy: a systematic review and meta-analysis. Gastroenterology 2019; 156: 1661-1674.e1611
    CrossrefPubMedGoogle Scholar
  • 10 Gessl I, Waldmann E, Penz D. et al. Evaluation of adenomas per colonoscopy and adenomas per positive participant as new quality parameters in screening colonoscopy. Gastrointest Endosc 2019; 89: 496-502
    CrossrefPubMedGoogle Scholar
  • 11 Park SK, Kim HY, Lee CK. et al. Comparison of adenoma detection rate and adenoma per colonoscopy as a quality indicator of colonoscopy. Scand J Gastroenterol 2016; 51: 886-890
    CrossrefPubMedGoogle Scholar
  • 12 Kahi CJ, Vemulapalli KC, Johnson CS. et al. Improving measurement of the adenoma detection rate and adenoma per colonoscopy quality metric: the Indiana University experience. Gastrointest Endosc 2014; 79: 448-454
    CrossrefPubMedGoogle Scholar
  • 13 Abdelfatah MM, Elhanafi S, Zuckerman MJ. et al. Correlation between adenoma detection rate and novel quality indicators for screening colonoscopy. A proposal for quality measures tool kit. Scand J Gastroenterol 2017; 52: 1148-1157
    CrossrefPubMedGoogle Scholar
  • 14 Mehrotra A, Morris M, Gourevitch RA. et al. Physician characteristics associated with higher adenoma detection rate. Gastrointest Endosc 2018; 87: 778-786.e775
    CrossrefPubMedGoogle Scholar
  • 15 Jover R, Zapater P, Bujanda L. et al. Endoscopist characteristics that influence the quality of colonoscopy. Endoscopy 2016; 48: 241-247
    Article in Thieme ConnectPubMedGoogle Scholar