Improving ADR Shown Again to Save Lives

Douglas K. Rex, MD, MASGE reviewing Lam AY, et al. Gastrointest Endosc 2020 Feb 21.

A 2017 study from the Polish screening colonoscopy program showed that when doctors improved their adenoma detection rate (ADR), their patients lowered their risk of interval colorectal cancer (CRC) after colonoscopy, compared to the risk before the quality program was initiated.

The current study was performed at a single center in the U.S., where in 2010, a quality program was instituted that involved increasing use of split-dose bowel preparation, withdrawal time measurement, ADR measurement, report cards, and educational and corrective sessions.

ADR was clearly associated with interval CRC risk, with a 77% reduction in patients who underwent colonoscopy performed by endoscopists in the highest ADR quartile compared to the lowest. Considering the entire group of GI doctors, interval CRC rates after institution of the quality program were reduced by 47%, including a 51% risk reduction of interval CRC in average-risk patients.

Comment:

The association of high ADR with low interval CRC rates remains extremely strong. This study adds to important evidence showing that improving ADR is possible and that improvement is followed by reduction in risk of interval CRC.

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

Citation(s):

Lam AY, Li Y, Gregory DL, et al. Association between improved adenoma detection rate and interval colorectal cancer rates after a quality improvement program. Gastrointest Endosc 2020 Feb 21. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2020.02.016)