Can I Improve My Adenoma Detection Rate?

Abstract

Adenoma detection rate (ADR) has emerged as a key quality metric for colonoscopy. Despite limitations, its major strength is based on its proven correlation with interval colorectal cancer. This has prompted extensive efforts to identify factors and interventions that improve ADR. Potentially modifiable factors that may influence ADR can be patient related (eg, bowel preparation), endoscopist related (eg, withdrawal time, quality of mucosal inspection, additional observers), or procedure related (eg, water infusion, additional examination of right colon, change in position, antispasmodics, colonoscopic equipment, and accessories). Providing endoscopists with educational material and/or feedback also seems to improve ADR.

Endocuff assisted colonoscopy significantly increases sessile serrated adenoma detection in veterans

“…Increases in ADR are inversely correlated with CRC mortality and post colonoscopy CRC rates (4,14,(16)(17)(18)(19). These findings have led the American College of Gastroenterology Task Force on Quality in Endoscopy and the American Society for Gastrointestinal Endoscopy to update their ADR targets to >30% for men and >20% for women (20).…”

“…Some of these include: high-resolution endoscopic imaging, narrowband endoscopic imaging, wide-angle colonoscopes, high definition colonoscopes, third eye retroscopes, Full Spectrum Endoscopy, balloon assisted colonoscopy (G-Eye), second forward view of the right colon and cecal retroflexion (19,(21)(22)(23)(24). The latest accessory devices in this field are the transparent cap colonoscopy (Endocap) and EC.…”

Water Exchange Versus Split-Dose Bowel Preparation and the ADR: Is WE There Yet?

“…Although affected by factors beyond the endoscopist's control such as the quality of bowel preparation, data strongly support an inverse correlation between the incidence of interval cancers and a low ADR [1]. The adverse effects of bowel preparation on the ADR have encouraged considerable research into improvement in bowel preparation quality.…”

Advances in endoscopic diagnosis of colorectal cancer

“…Novel methods were therefore developed to overpass anatomical difficulties of the colon, enable more accurate, even microscopic identification of abnormalities in the size, density and shape of crypts and vessels [13,[16][17][18]. They can be roughly divided into three categories, ones that improve overall mucosal examination and increase the polyp detection, those that enable more thorough examination (almost histological) of the detected lesions and minimally invasive techniques.…”