COMPARISIONS OF COLONOSCOPY QUALITY INDICATORS FOR THE PREDICTION OF ADENOMA MISS RATE

Aims:

Adenoma detection rate (ADR) is most widely used as an indicator of quality for colonoscopy. However, high ADR alone do not guarantee the complete removal of adenomas due to limitation of definition of ADR. Therefore, other optimal indicator is needed to better reflect the quality of colonoscopist. In our study, we analyzed the association of several quality indicators such as the total adenomas per colonoscopy (APC), adenoma per positive participants (APP) and ADR-plus with adenoma missed rate (AMR).

Methods:

Patients who underwent more than two total colonoscopy for screening, surveillance within 3 years in Korea University Ansan Hospital between January 2011 and February 2016 were included. AMR and AMR more than 5 mm miss rate (AMR> 5 mm) were calculated from 9 endoscopists who performed total colonoscopy more than 50 times as a first colonoscopist. ADR, APC, APP and ADR plus were calculated from patients with age over 40 years.

Results:

A total of 716 patients aged ≥40 years were analyzed retrospectively. Mean age was 58.9 years and male was 450 (62.8%). And mean time interval between colonscopic exams was 21.6 months. There were no significant differences in age, sex, bowel preparation quality and mean time interval between colonoscopic exams among nine endoscopists. AMR was 0.36, 0.38, 0.45, 0.28, 0.43, 0.35, 0.28, 0.24 and 0.37. AMR> 5 mm was 0.35, 0.23, 0.24, 0.22, 0.29, 0.35, 0.18, 0.20 and 0.35, respectively. AMR was not significantly correlated with all quality indicators. Whereas APC had a significant inverse correlation with AMR> 5 mm (r =-0.729, p= 0.026), the other indicators were not significantly correlated with AMR> 5 mm (r for ADR =-0.221, p= 0.567; r for ADR plus =-0.661, p= 0.053, r for APP =-0.638, p= 0.064).

Conclusions:

APC had the significant negative association with AMR> 5 mm. APC might be a better quality indicator for meticulous colonoscopist.