The ASGE Quality Course: Improving Quality and Safety in the Endoscopy Unit (Virtual) | November 2025-Defining and Measuring Quality in Colonoscopy

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This comprehensive presentation by Dr. Theodore R. Levin updates quality indicators for colonoscopy, emphasizing their critical role in colorectal cancer (CRC) prevention. Colonoscopy is the most common US endoscopic procedure, directly linked to decreased CRC incidence and mortality; however, variability among endoscopists impacts effectiveness, necessitating standardized quality measures.<br /><br />Key updated priority quality indicators include: <br />- Adenoma Detection Rate (ADR) at 35% overall (40% for men, 30% for women) for all indications (screening, diagnostic, surveillance), replacing the former 25% screening-only target. ADR is the most important measure, strongly inversely correlated with post-colonoscopy CRC (PCCRC) risk.<br />- Sessile Serrated Lesion Detection Rate (SSLDR) with a new 6% target, important as these lesions contribute to interval cancers.<br />- Use of recommended surveillance intervals at 90% adherence, addressing widespread overuse and underuse of colonoscopy.<br />- Adequate bowel preparation (≥90%), essential for effective mucosal inspection.<br />- Cecal intubation rate at 95%, which can be measured intermittently to confirm complete examination.<br /><br />The presentation reviews reasons for interval cancers—missed lesions, incomplete resections, and new lesions—and highlights data showing improved outcomes with higher ADR and SSLDR. Withdrawal time during colonoscopy should target 8-9 minutes with proper technique to enhance detection.<br /><br />Additional quality aspects include polyp resection documentation and cold snare use for small polyps. Feedback, training, and report cards are effective for quality improvement. Overall, colonoscopy quality reporting enables measurable improvement and better cancer prevention outcomes. Dr. Levin stresses focusing on priority indicators as "you can only improve what you can measure," encouraging ongoing efforts to optimize colonoscopy quality for patient benefit.

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TR Levin, MD

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Concept Colonoscopy Quality

Concept Adenoma Detection Rate

Concept Sessile Serrated Lesion Detection Rate

Concept Colonoscopy Bowel Preparation Adequacy

Concept Cecal Intubation Rate

Keywords

Colonoscopy quality indicators

Adenoma Detection Rate (ADR)

Sessile Serrated Lesion Detection Rate (SSLDR)

Colorectal cancer prevention

Surveillance interval adherence

Bowel preparation quality

Cecal intubation rate

Post-colonoscopy colorectal cancer (PCCRC)

Polyp resection documentation

Colonoscopy withdrawal time

Colonoscopy Quality

Adenoma Detection Rate

Sessile Serrated Lesion Detection Rate

Colonoscopy Bowel Preparation Adequacy

Cecal Intubation Rate