Adenoma Detection Rate Can Be Measured in Combined Screening, Surveillance, and Diagnostic Examinations

Douglas K. Rex, MD, MASGE reviewing Kaltenbach T, et al. Clin Gastroenterol Hepatol 2021 Feb 18.

When the adenoma detection rate (ADR) was originally proposed as a quality measure in 2002, the recommendation did not constrain its indication to screening colonoscopies only. The recommendation to limit the use of ADR measurement to screening colonoscopies was made in 2006 because the target thresholds had been derived from screening studies. However, surveillance ADRs are typically higher than screening ADRs, which are higher than diagnostic ADRs, so that all 3 combined often result in an ADR close to the screening-only ADR. This was demonstrated in a previous single-center study and could lead to simplifying the ADR measurement. 

In a study conducted in Veterans Affairs hospitals involving 2628 procedures, the distribution of screening examinations was 29%, surveillance was 48%, and diagnostic was 23%, with only a tiny fraction (0.49%) having a fecal immunochemical test (FIT)-positive indication. The ADRs were 56% for surveillance, 49% for screening, and 38% for diagnostic examinations. Nonscreening examinations combined had an ADR of 50%. Over a range of indication scenarios (varying the fraction of screening, surveillance, and diagnostic examinations), the ADR for screening and overall ADRs remained quite similar.


We are approaching enough evidence to revert to the original recommendation for ADR measurement: a measure in colonoscopies regardless of the indication in all persons age 50 and older without inflammatory bowel disease or polyposis syndromes. However, exclusion of FIT-positive and Cologuard-positive persons would still be required if the recommendations comprise any significant fraction of indications.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, MASGE

Bio and Disclosures


Kaltenbach T, Gawron A, Meyer CS, et al. Adenoma detection rate (ADR) irrespective of indication is comparable to screening ADR: implications for quality monitoring. Clin Gastroenterol Hepatol 2021 Feb 18. (Epub ahead of print) (