Key points from the article include:
Importance of Quality in Colonoscopy: Quality is crucial in using colonoscopy to reduce the risk of cancer. There are several performance improvements that can be made in practices to enhance the quality of colonoscopies.
Increasing the Adenoma Detection Rate (ADR): The current nationally recommended benchmark for ADR is 25%, which is considered low. The GIQuIC registry data shows an ADR rate closer to 39%, and in high-level detectors, it’s over 50%. Techniques to increase ADR include using mucosal exposure techniques, electronic chromoendoscopy, and new artificial intelligence options, which can increase ADR by approximately 10%.
ADR in Fecal Immunochemical Test (FIT)–Positive Patients: FIT-positive status increases the ADR threshold by 15%-20%, placing the ADR range at about 50% for screening patients presenting for colonoscopy due to FIT positivity.
Adenoma Per Colonoscopy (APC) as an ADR Substitute: Growing evidence supports using APC as a substitute for ADR. This allows recording every adenoma and attributing it to the index colonoscopy. A high-quality paper suggested that the APC value should be around 0.6 to achieve the current ADR minimum threshold of 25%. An APC less than 0.6 is associated with an increased risk for residual polyp and interval colorectal cancer.
Need for Remedial Corrective Work: The article suggests that doctors with an ADR of 25% or greater but with APCs less than 0.6 need to be reevaluated, retrained, and educated on ways to incorporate these findings. The APC in high-level detectors is greater than 1.0.
In summary, the article by Dr. David Johnson emphasizes the importance of improving colonoscopy quality through various techniques and metrics, highlighting the need for ongoing education and training in the field to enhance patient outcomes.