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Average U.S. Adenoma Detection Rate Hits 40%

Douglas K. Rex, MD, MASGE reviewing Shaukat A, et al. Am J Gastroenterol 2021 Jun 23.

Currently recommended minimum thresholds for adenoma detection rates (ADRs), defined as the fraction of patients undergoing first-time screening colonoscopy who have one or more conventional adenomas detected and identified by pathology, are 30% for men and 20% for women, or 25% overall for a mixed-gender patient population. Some evidence suggests that increasing the ADR threshold up to 50% provides continued protection against postcolonoscopy cancer.

These researchers reviewed colonoscopy data obtained from the quality benchmarking registry GI Quality Improvement Consortium (GIQuIC), a collaboration between the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy. The mean ADR for more than 2.6 million colonoscopies performed by 1169 endoscopists increased from 33.9% in 2014 to 38.1% in 2018. When the numbers were adjusted to the U.S. population aged 50 years and older using 2010 census data, the adjusted screening ADR overall was 39.08% and increased from 36.4% in 2014 to 40.0% in 2018. Adjusted ADR was higher for surveillance examinations (47.3%) and lower for diagnostic colonoscopies (34.1%). 

Higher ADRs were associated with older age, male gender, surveillance indication versus screening, and longer withdrawal times.


These are important benchmarking data, though they could be higher than overall performance in the U.S. because participants likely are more interested than nonparticipants in quality improvement. Nevertheless, the study authors emphasize that currently recommended thresholds should be regarded as minimums and even endoscopists with a screening ADR in the 30% to 40% range should view themselves as below mean performance and take an interest in improvement. The findings also reinforce recent observations that confining ADR measurement to screening alone may not be warranted and that all surveillance, screening, and diagnostic examinations, except for positive stool tests and IBD and polyposis syndrome examinations, could be included in ADR calculations.
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


Shaukat A, Holub J, Pike IM, et al. Benchmarking adenoma detection rates for colonoscopy: results from a US-based registry. Am J Gastroenterol 2021 Jun 23. (Epub ahead of print) (