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Archive January 2020 XXI, No. 1

Boost Your Adenoma Detection Rate

ADR is the gold standard in colonoscopy quality. Do you measure up?

Jared Bilski


Pamela Bevelhymer, RN, BSN, CNOR
NO SUBSTITUTE High-definition scopes detect adenomas at a higher rate than older, standard-def scopes.

There are plenty of metrics you can use to measure the effectiveness of the colonoscopies your GI docs perform, but none are more important than adenoma detection rate (ADR) — the rate in patients 50 and older undergoing first-time colonoscopy screenings who have 1 or more adenomas detected and removed.

Studies ( show that ADR is inversely correlated to the rates of interval colorectal cancer risk (iCRC) — those cancers that may develop due to missed or incompletely resected polyps. Let's look at how your endoscopists can get ADR above the recommended minimum, which the American Society for Gastrointestinal Endoscopy (ASCE) and the American College of Gastroenterology's (ACG) Taskforce on Quality in Endoscopy put at 25% for all patients (30% for men; 20% for women).

1. Technique is tantamount. As innovations in colonoscopy tech continue to emerge, it may be tempting to rely too heavily on the stunning HD-quality imagery, nearly 360-degree angle, wall-to-wall views of the colon or even artificial intelligence during screenings, but technology will never replace technique. Physicians must be competent, confident and consistent at detecting and removing polyps. What do all gastroenterologists with above average ADR rates have in common? "They come into every procedure with a very detailed understanding of what precancerous lesions look like in the colon," says gastroenterologist Douglas K. Rex, MD, a professor at Indiana University-Purdue University in Indianapolis. "They understand what serrated and adenomatous polyps look like," adds Dr. Rex. And the physicians who don't? They're likely missing critical methods for adenoma detection. These are the GI docs who don't expose all of the mucosa when they're passing the scope through the haustral fold, who don't realize the fold has hidden some mucosa from view and don't work at going back in and poking the tip of the scope in between those folds and exposing that mucosa, says Dr. Rex.

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