Quality in Endoscopy

Quality in endoscopy

Excerpt from Gastrointestinal endoscopy (GIE Journal)

Quality indicators for GI endoscopic procedures
Volume 100, Issue 3
p382-394September 2024

"The field of endoscopy has evolved substantially in recent years, with advances in procedural capabilities, technologies, and delivery models. One constant, however, has been the commitment of professional societies, including the American Society for Gastrointestinal Endoscopy (ASGE) and the American College of Gastroenterology (ACG)—the 2 co-sponsors of this series—to the delivery of high-quality endoscopic care. This commitment is reflected, in part, by quality indicator documents, which aim to provide endoscopists and practices a framework through which quality improvement efforts can be operationalized.

Generally speaking, quality in health care is the degree to which health services for individuals and populations increase the likelihood of a desired outcome and are consistent with current professional knowledge.1 In the endoscopic context, a high-quality procedure is one that is clearly indicated, during which relevant diagnoses are established or excluded, any therapy provided is appropriate and effective, and harm is minimized to the greatest extent possible. Toward this ideal, quality indicators have been developed to compare the performance of an individual or a group of individuals with available benchmarks."

What is your doctor's Adenoma Detection Rate (ADR)?
What about Average Withdrawal Time?
GIE Journal: Quality in Endoscopy Metrics & Benchmarks
Rethinking Post-colonoscopy Colorectal Cancer Risk: Endoscopist Performance Versus Presence of High-risk Polyps

What is your doctor's Adenoma Detection Rate (ADR)?

What is your doctor’s Adenoma Detection Rate (ADR) and why should you care?

Adenoma detection rate, or ADR, is a numeric value that represents the percentage of times your gastroenterologist detects a precancerous polyp during screening colonoscopies. This number is considered a benchmark of quality and care, as it indicates how thorough your doctor will be during your examination.

Although gastroenterologists undergo the most extensive training in performing colonoscopies, their rates of polyp detection can vary significantly. When interviewing gastroenterologists to perform your procedure, look for a physician with an ADR of at least 25 percent in men and 15 percent in women. The higher the ADR, the better.

Research shows that for every 1% increase in a physician’s ADR, your risk of developing colon cancer over the next year decreases by 3%, and a 5% decrease in risk of a fatal interval cancer.

Conclusions of this study: the adenoma detection rate was inversely associated with the risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer.

— Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5723728/#r7

What about Average Withdrawal Time?

endoscopy,at,the,hospital.,doctor,holding,endoscope,before,gastroscopy.,medical What else should you ask your doctor?

You may feel a little uneasy asking your potential doctor about providing an ADR, but rest assured that this is a reasonable request. Qualified gastroenterologists take pride in their hard-earned ADRs, and they will be happy to share this information with you. You should also enquire about your physician’s average withdrawal time, which is the amount of time it takes to remove the scope from the colon. You want a gastroenterologist with an average withdrawal time of at least six minutes.

Finding the right gastroenterologist may require a bit of courage and assertiveness, but it is well worth the effort. Make a list of questions to ask when interviewing potential physicians, and be sure to include ADR and average withdrawal time. A high-quality physician is the key to a thorough examination and a future without colon cancer.

Why is the Average Withdrawal Time important?

Adenoma detection was strongly associated with longer withdrawal times: endoscopists whose withdrawal times were more than 6 minutes detected more than twice as many patients with adenomas that were 1cm or larger in size.

(Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099297/)

GIE Journal: Quality in Endoscopy Metrics & Benchmarks

gie

Click on the article titles to view on GIE Journal‘s website

Rethinking Post-colonoscopy Colorectal Cancer Risk: Endoscopist Performance Versus Presence of High-risk Polyps

AGA Clinical Gastroenterology and Hepatology

Clinical Gastroenterology and Hepatology

Volume 23, Issue 10, September 2025, Pages 1846-1853.e4

Background and Aims

Current post-polypectomy guidelines set intervals based solely on features of resected polyps. Despite the well-known inverse relationship between both adenoma detection rate (ADR) and proximal serrated polyp detection rate (PSPDR) with post-colonoscopy colorectal cancers (PCCRCs), both quality indicators are not considered when determining surveillance intervals.

Methods

We used colonoscopy data from 2014 to 2020 performed for a positive fecal immunochemical test in the Dutch colorectal cancer screening program. Individuals were categorized into having high-risk polyps or no/low-risk polyps resected. The association between 3-year PCCRC-risk and presence of high-risk polyps and either ADR or PSPDR was studied with Cox proportional hazard regression. Secondly, endoscopists were categorized into low/medium/high ADR and PSPDR to enable stratified analysis.

Results

A total of 239,217 individuals were included; 74,289 had high-risk polyps resected at baseline and 202 had PCCRC within the subsequent 3 years. Presence of high-risk polyps was not associated with PCCRC-risk (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.75–1.35), whereas ADR and PSPDR showed a strong association with PCCRC (per point increase HR, 0.94; 95% CI, 0.92–0.96; HR, 0.92; 95% CI, 0.89–0.95, respectively). For individuals with no/low-risk polyps but examined by endoscopists with low ADR, the HR of PCCRC was 2.11 (95% CI, 1.21–3.65), as compared with individuals with high-risk polyps but examined by endoscopists with high ADR.

Conclusions

An individual’s PCCRC risk in the initial years is primarily influenced by endoscopist performance, rather than the presence of high-risk polyps. To reduce PCCRCs, besides ensuring appropriate surveillance intervals, it is crucial to monitor and audit endoscopist quality indicators.