Abstract
Background and study aims In 2015, the American Society for Gastrointestinal Endoscopy (ASGE) and American
College of Gastroenterology (ACG) Task Force on Quality in Endoscopy deemed adenoma
detection rate (ADR) the most important quality measure for colonoscopy. There has
been much interest in factors that can increase ADR. To date, however, few studies
have looked at what intra-procedural endoscopist practices are associated with improving
ADR. We conducted a retrospective review of colonoscopy videos to evaluate intra-procedural
practices that could be associated with ADR.
Methods Videos were recorded of colonoscopies performed between September and December 2017
at the Palo Alto Veterans Affairs Health Care System. Colonoscopies for screening
and surveillance were included for video review. Factors assessed included withdrawal
time, intra-procedural cleaning, inspection technique, and other variables (colon
distention, removal of equivocal/hyperplastic polyps). A series of multiple regression
analyses was conducted on variables of interest before running a final model of significant
predictors.
Results A total of 130 videos were reviewed from nine endoscopists whose ADRs ranged between
37.5 % and 73.7 %. The final regression model was significant (F = 15.35, df = 2,
P = 0.0044), R2 = 0.8365) with close inspection of behind folds and quality of cecal inspection being
the factors highly correlated with predicting ADR. Withdrawal and inspection times,
colonic wall distention, removal of equivocal/hyperplastic polyps, quality of rectal
inspection, suctioning, and washing were factors moderately correlated with predicting
ADR.
Conclusions We found that behind-fold inspection and a meticulous cecal inspection technique
were predictive of a high ADR.
