GI Unit Leadership: Shaping a High-Performing Endoscopy Unit (Virtual) | February 2026-ASGE ACG quality indicators

ASGE ACG quality indicators_colonoscopy

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This comprehensive document from the American Society for Gastrointestinal Endoscopy (ASGE) and the American College of Gastroenterology (ACG) updates quality indicators for colonoscopy, a critical procedure for colorectal cancer (CRC) prevention. Colonoscopy reduces CRC incidence and mortality, particularly in the left colon, but its effectiveness highly depends on operator performance. The document emphasizes the need for consistent quality measurement to improve outcomes.<br /><br />Priority quality indicators include adenoma detection rate (ADR), sessile serrated lesion detection rate (SSLDR), adherence to recommended screening and surveillance intervals, bowel preparation adequacy, and cecal intubation rate (CIR). ADR, defined as the percent of patients with at least one conventional adenoma detected, is central; the recommended ADR threshold is raised to ≥35% (40% in men, 30% in women) reflecting recent evidence and inclusion of patients aged ≥45 years. SSLDR, newly emphasized, targets detection of precancerous serrated lesions with a suggested minimum rate of ≥6%, given its independent association with post-colonoscopy colorectal cancer risk. CIR measurement remains important but may be intermittently monitored once high performance is established.<br /><br />Other technical indicators involve detailed documentation of polyp characteristics (size, shape, location, resection method) and promoting cold snare polypectomy for 4-9 mm lesions, which reduces risks compared to hot techniques. Withdrawal time recommendations specify a minimum average of 8 minutes in normal colonoscopies to maximize lesion detection.<br /><br />Postprocedure quality indicators stress compliance with evidence-based screening and surveillance intervals to balance benefits and costs, recommending at least 90% adherence. Serious adverse events (perforation, bleeding, mortality) must be tracked and reviewed systematically to implement improvements.<br /><br />For inflammatory bowel disease (IBD), the document advises formal assessments of disease activity using validated scoring systems (e.g., Mayo Endoscopic Score for ulcerative colitis, Simple Endoscopic Activity Score for Crohn’s disease) during colonoscopy, and appropriate surveillance intervals for dysplasia.<br /><br />The report underscores that identification of poor performance through measurement must be followed by multifaceted corrective interventions—such as feedback, technique training, bowel prep optimization, position changes, and emerging technologies like artificial intelligence—to enhance adenoma and serrated lesion detection, thereby improving patient outcomes and reducing interval cancers.

Keywords

colonoscopy

colorectal cancer prevention

adenoma detection rate

sessile serrated lesion detection rate

bowel preparation adequacy

cecal intubation rate

cold snare polypectomy

withdrawal time

inflammatory bowel disease assessment

artificial intelligence in endoscopy