Background
Endoscopist quality is benchmarked by the adenoma detection rate (ADR)—the proportion
of cases with 1 or more adenomas removed. However, the ADR rewards the same credit
for 1 versus more than 1 adenoma.
Objective
We evaluated whether 2 endoscopist groups could have a similar ADR but detect significantly
different total adenomas.
Design
We retrospectively measured the ADR and multiple measures of total adenoma yield,
including a metric called ADR-Plus, the mean number of incremental adenomas after
the first. We plotted ADR versus ADR-Plus to create 4 adenoma detection patterns:
(1) optimal (↑ADR/↑ADR-Plus); (2) one and done (↑ADR/↓ADR-Plus); (3) all or none (↓ADR/↑ADR-Plus);
(4) none and done (↓ADR/↓ADR-Plus).
Setting
Tertiary-care teaching hospital and 3 nonteaching facilities servicing the same patient
pool.
Patients
A total of 3318 VA patients who underwent screening between 2005 and 2009.
Main Outcome Measurements
ADR, mean total adenomas detected, advanced adenomas detected, ADR-Plus.
Results
The ADR was 28.8% and 25.7% in the teaching (n = 1218) and nonteaching groups (n =
2100), respectively (P = .052). Although ADRs were relatively similar, the teaching site achieved 23.5%,
28.7%, and 29.5% higher mean total adenomas, advanced adenomas, and ADR-Plus versus
nonteaching sites (P < .001). By coupling ADR with ADR-Plus, we identified more teaching endoscopists
as optimal (57.1% vs 8.3%; P = .02), and more nonteaching endoscopists in the none and done category (42% vs 0%;
P = .047).
Limitations
External generalizability, nonrandomized study.
Conclusion
We found minimal ADR differences between the 2 endoscopist groups, but substantial
differences in total adenomas; the ADR missed this difference. Coupling the ADR with
other total adenoma metrics (eg, ADR-Plus) provides a more comprehensive assessment
of adenoma clearance; implementing both would better distinguish high- from low-performing
endoscopists.
Abbreviations:
ADR (adenoma detection rate), WLAVA (West Los Angeles Veterans Administration), CRC (colorectal cancer)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
August 30,
2012
Received:
April 19,
2012
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. This research was supported by a Veterans Affairs Merit Award (IIR 08-310) to Dr Spiegel and an NIH training grant (T32DK07180-34) to Dr Wang.
See CME section; p. 108.
The opinions and assertions contained herein are the sole views of the authors and are not to be construed as official or as reflecting the views of the Department of Veteran Affairs.
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
