Predictive factors for adenoma detection rates: a video study of endoscopist practices

• Published in: Endoscopy International Open Vol. 9; no. 2; pp. E216 - E223
• Main Authors: Yang, Sun Young, Quan, Susan Y., Friedland, Shai, Pan, Jennifer Y.
• Format: Journal Article
• Language: English
• Published: Rüdigerstraße 14, 70469 Stuttgart, Germany Georg Thieme Verlag KG 01-02-2021
• Subjects: Original article
• ISSN: 2364-3722; 2196-9736
• DOI: 10.1055/a-1321-0990

Abstract
Background and study aims
 In 2015, the American Society for Gastrointestinal Endoscopy (ASGE) and American College of Gastroenterology (ACG) Task Force on Quality in Endoscopy deemed adenoma detection rate (ADR) the most important quality measure for colonoscopy. There has been much interest in factors that can increase ADR. To date, however, few studies have looked at what intra-procedural endoscopist practices are associated with improving ADR. We conducted a retrospective review of colonoscopy videos to evaluate intra-procedural practices that could be associated with ADR.
Methods
 Videos were recorded of colonoscopies performed between September and December 2017 at the Palo Alto Veterans Affairs Health Care System. Colonoscopies for screening and surveillance were included for video review. Factors assessed included withdrawal time, intra-procedural cleaning, inspection technique, and other variables (colon distention, removal of equivocal/hyperplastic polyps). A series of multiple regression analyses was conducted on variables of interest before running a final model of significant predictors.
Results
 A total of 130 videos were reviewed from nine endoscopists whose ADRs ranged between 37.5 % and 73.7 %. The final regression model was significant (F = 15.35, df = 2,
P
 = 0.0044), R
2
 = 0.8365) with close inspection of behind folds and quality of cecal inspection being the factors highly correlated with predicting ADR. Withdrawal and inspection times, colonic wall distention, removal of equivocal/hyperplastic polyps, quality of rectal inspection, suctioning, and washing were factors moderately correlated with predicting ADR.
Conclusions
 We found that behind-fold inspection and a meticulous cecal inspection technique were predictive of a high ADR.