Improving Quality and Safety in the Endoscopy Unit (On-Demand) | October 2024-ASGE Interventions to Improve ADR

ASGE Interventions to Improve ADR

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The document from the American Society for Gastrointestinal Endoscopy (ASGE) reviews strategies to enhance adenoma detection rate (ADR) during colonoscopies, a critical measure for colorectal cancer (CRC) prevention. Colonoscopy remains the dominant method for CRC screening in the U.S., reducing CRC incidence and mortality significantly. However, the procedure's effectiveness varies due to missed adenomas and interval cancers, highlighting the need for quality improvements.<br /><br />Key interventions to improve ADR focus on techniques, technologies, systemic interventions, and education. Techniques include water-assisted colonoscopy, lengthened withdrawal time, second looks in the colon's right side, and dynamic patient positioning. Water-exchange colonoscopy, for example, can improve the ADR by up to 10 percentage points compared to traditional methods.<br /><br />Technological interventions involve the use of distal attachment devices, enhanced imaging technologies (like narrow-band imaging), and computer-aided detection systems, all of which show significant improvements in ADR. Specifically, technologies like computer-aided detection can increase ADR by around 10%.<br /><br />Systematic interventions look at bowel preparation techniques, such as split-dose preparation, which significantly boosts ADR, whereas same-day preparations offer similar effectiveness to split-dosing. Moreover, including a second observer during the procedure can enhance ADR substantially.<br /><br />Educational interventions, such as providing physician report cards and focused training, also play a crucial role. Report cards have shown to improve ADR by 10 to 19 percentage points, while educational programs enhance inspection quality significantly.<br /><br />The document suggests that these interventions can vary in cost, effort, and implementation strategies but generally aim to increase ADR by 8% to 10%. It encourages choosing interventions aligned with available resources while noting the importance of sustained improvements in colonoscopy quality and ADR monitoring.

Keywords

adenoma detection rate

colonoscopy

colorectal cancer prevention

ASGE

water-assisted colonoscopy

enhanced imaging technologies

computer-aided detection

bowel preparation techniques

physician report cards

quality improvements