ASGE Masterclass: Colonoscopy (Virtual Only) | January 2022-5_Shaukat

5_Shaukat_Improving ADR

Pdf Summary

Maximizing your Adenoma Detection Rate is an important quality metric in colonoscopy. The benchmark for this rate is 25%, but the aspirational goal is 50%. Research has shown that each 1% increase in Adenoma Detection Rate is associated with a 3% decrease in the risk of colorectal cancer and a 5% decrease in the risk of fatal colorectal cancer. Therefore, improving this rate can have significant impacts on patient outcomes.<br /><br />There are several steps and interventions that can be taken to improve the Adenoma Detection Rate. Firstly, it's important to measure and report quality indicators, such as the ADR, and provide report cards to individual physicians and groups. Public "report cards" can also be published to increase transparency.<br /><br />Improving bowel preparation is another critical step. Using split dose or same-day prep and ensuring adequate preparation in at least 85% of cases can greatly enhance the ADR. Recognizing and resecting easily missed polyps, particularly right-sided, flat/sessile, irregular, and mucus-covered ones, is crucial.<br /><br />Technique plays a significant role in maximizing ADR. Withdrawal time should be at least 6 minutes in colonoscopies without biopsy or polypectomy, and special attention should be given to factors like distention, cleaning, looking behind folds, and segmental inspection.<br /><br />Technology can also aid in improving ADR, including the use of accessory devices and emerging artificial intelligence (AI) technologies for polyp detection, histology prediction, prep quality assessment, and more.<br /><br />Multifaceted interventions are often necessary, combining techniques, technology, and education. Educational programs, leadership training, video recording with feedback, and continuous feedback can all be effective in improving ADRs.<br /><br />In summary, maximizing the Adenoma Detection Rate is crucial for high-quality colonoscopy screenings. By implementing a combination of techniques, technology, and education, healthcare providers can improve ADRs and reduce the risk of colorectal cancer and fatal outcomes.

Keywords

Adenoma Detection Rate

colonoscopy

quality metric

benchmark

aspirational goal

colorectal cancer

fatal colorectal cancer

bowel preparation

technique

technology