GI Unit Leadership: Optimizing Endoscopy Operations through Leadership (Virtual) | February 2025-ASGE interventions to improve ADR

ASGE interventions to improve ADR

Pdf Summary

The American Society for Gastrointestinal Endoscopy's (ASGE) Quality Assurance in Endoscopy Committee has published a detailed document aimed at improving adenoma detection rates (ADR) in colonoscopy, a key measure of colonoscopy quality. More than 19 million colonoscopies are conducted annually in the U.S., largely to screen for colorectal cancer (CRC). While colonoscopy can significantly reduce CRC incidence and mortality, the procedure's quality varies, prompting a focus on enhancing ADR to curb missed adenomas and interval cancers, which occur between screenings.<br /><br />The document highlights several interventions across four categories: techniques, technology, systemic interventions, and education/feedback. Techniques such as water-assisted colonoscopy, extended withdrawal times, dual examination approaches, and dynamic patient positions during withdrawal are linked to improved ADR. Technological advancements like distal attachment devices, enhanced imaging, and artificial intelligence offer notable improvements in ADR by increasing the visibility and detection of adenomas.<br /><br />Systematic changes, mainly involving bowel preparation, reveal that split-dose methods significantly increase ADR over day-before preparations. Though same-day preparations don't show a measurable improvement over split-dosing, both are better than day-before options. The presence of a second observer—like an experienced nurse or additional endoscopist—during colonoscopy potentially boosts ADR. Video recording of procedures alone, however, does not significantly impact ADR but can spotlight improvement areas for endoscopists.<br /><br />Educational interventions and regular feedback through report cards or public reporting can also improve ADR, specifically benefiting below-average performers. While financial incentives have minimal impact on ADR improvement, transparency in performance reporting may encourage better outcomes.<br /><br />Ultimately, a combination of interventions, chosen based on available resources, could provide a cost-effective strategy for endoscopists to improve ADR and enhance the overall effectiveness of colonoscopies in CRC prevention. The emphasis on developing tailored intervention plans underscores the commitment to high-value care and colonoscopy's preventive potential.

Keywords

adenoma detection rates

colonoscopy quality

colorectal cancer screening

ASGE guidelines

endoscopy techniques

artificial intelligence

bowel preparation

educational interventions

performance reporting

preventive care