So, in summary, ADR is a valid quality metric that should be tracked and can be improved. Good technique is essential, and the elements are careful segmental inspection, looking behind folds, segmental and time withdrawal, looking for flat lesions, and using techniques such as water exchange. Technology can help but is not a substitute by itself. And educational programs can really help, but there is effort and cost involved. And I'll lead you with this slide again, which again summarizes many of the tools we talked about and their range in the amount of effort and cost involved, but they all seem to have a benefit in improving adenoma detection rate. And with that, I'll stop and open the line for questions. Thank you, Dr. Shaka. Again, we thank you for joining us today for assembling an ADR Improvement Toolkit for your practice. At this time, Dr. Shaka will address questions received from the audience. As a reminder, you can submit a question through the GoToWebinar dialog box, so we have that on screen, so you can see where you can type in your own questions there. And our first question, Dr. Shaka, is, should I include sessile serrated adenomas in my calculation for ADR? Yeah, that's a very good question and an important one to ask. The answer is no. That's because we really want to compare apples to apples. With sessile serrated adenomas, the trouble is there's a lot of variation in how pathologists read it. So while it's a very important endpoint to detect, and these lesions are very important, so from the quality standpoint, it's important to detect sessile serrated lesions. However, more than the endoscopist, it might be the pathologist that might determine whether it's an SSA or not. So for that reason, to compare apples to apples, we should only include conventional adenomas, which include tubular adenomas, tubulovilus, villus by itself, or a tubular adenoma with high-grade dysplasia in the calculation of ADR. Hey, Asma, this is Doug. I'm on the phone. Can you hear me? We sure can, Dr. Rex. Thank you for joining us. And this is our special guest, Dr. Rex, joining Dr. Chakot for our Q&A section. Did you have more comments on that, Dr. Rex? No, that was a good answer by her. She was absolutely right. This is for what we call conventional adenomas for the ADR. But as she said, we definitely want to find those lesions. If you want to, in your own practice, set up a separate detection target for patients who have one or more cefalocerated polyps or cefalocerated adenomas, whatever the term is that you use, then there's some evidence that suggests that if you're in the vicinity of 8% to 9%, you're pretty good at it. Recent studies suggest that experts are getting even higher in screening populations. And of course, you've got to have a pathologist who's tuned into it. But for right now, it shouldn't be part of the ADR.

adenoma detection rate

endoscopy

technique

water exchange

conventional adenomas