Updated Colonoscopy Quality Indicators: What They Mean for Your Practice | September 2024-ASGE Interventions to Improve ADR

ASGE Interventions to Improve ADR

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The document summarizes a detailed review by the American Society for Gastrointestinal Endoscopy (ASGE) focused on improving adenoma detection rates (ADR) during colonoscopy. Conducted by a team of gastroenterology experts and reviewed by the ASGE Governing Board, it highlights the importance of colonoscopy in colorectal cancer (CRC) prevention through adenoma detection and removal.<br /><br />Key Findings:<br />- Colonoscopy reduces CRC incidence and mortality but has variable quality in the U.S., with adenoma miss rates between 9% and 26%.<br />- Improving ADR, the proportion of patients in whom an adenoma is found, could significantly reduce interval CRC rates.<br />- Suggested ADR benchmarks are 30% for men and 20% for women aged 50 and older.<br /><br />Interventions categorized into four domains were reviewed:<br />1. **Techniques:**<br />   - Water assistance methods like water exchange (WE) during colonoscopy significantly increase ADR by up to 10%.<br />   - Lengthening withdrawal time to 8-9 minutes enhances ADR by up to 9%.<br />   - Techniques such as cecal retroflexion, a second forward look, and dynamic patient position changes during withdrawal can increase ADR by up to 17%.<br /><br />2. **Technology:**<br />   - Distal attachment devices and enhanced imaging technologies (e.g., narrow-band imaging, computer-aided detection) were found to increase ADR by 5-18% and up to 10%, respectively.<br />   <br />3. **Systemic Interventions:**<br />   - Split-dose bowel preparation before colonoscopy significantly increases ADR compared to day-before prep by 26%.<br />   - Use of same-day bowel preparations and involvement of a second observer such as a nurse increased ADR by up to 19%.<br /><br />4. **Education and Feedback:**<br />   - Report cards for endoscopists, focused educational interventions, and possibly public reporting resulted in ADR improvements by 10-25%.<br />   - Financial incentives showed no significant impact on ADR improvement.<br /><br />Conclusion:<br />The document underscores the multifaceted approaches to enhancing ADR, recommending low-cost, high-impact techniques like optimal withdrawal techniques and water exchange, and broader systemic implementations such as split-dose preparation and educational feedback for sustained quality improvements in colonoscopy practices.

Keywords

adenoma detection rate

colonoscopy

colorectal cancer

ASGE

water exchange

withdrawal techniques

enhanced imaging

bowel preparation

educational feedback

endoscopy