Do We Keep Measuring and Measuring and Measuring Adenoma Detection Rate?

Do We Keep Measuring and Measuring and Measuring Adenoma Detection Rate?

Douglas K. Rex, MD, MASGE, reviewing El Rahyel A, et al. Gastrointest Endosc 2021 Oct 20.

The adenoma detection rate (ADR), first recommended by the U.S. Multi-Society Task Force on Colorectal Cancer in 2002, is a validated predictor of colorectal cancer after colonoscopy and has become the premier quality indicator for colonoscopy. 

In this single-center study of 11 endoscopists who performed at least 50 screening colonoscopies per year for 5 consecutive years, overall ADR was 42%. Over the study period, the average annual ADR of 5 of the 11 endoscopists increased significantly, ranging from 0.8% to 6.3% growth. The other 6 endoscopists had statistically stable ADRs during the study period, and none of them had a decline in ADR.

Douglas K. Rex, MD, FASGE


Other data support the observation that ADR trends up over time and rarely declines. Thus, although measuring and improving ADR are important, endoscopists with ADRs well above the minimum threshold are very unlikely to fall below the minimum acceptable threshold. In practices where ADR measurement is still resource-intensive, the intermittent measurement of ADR might be acceptable, particularly for endoscopists who perform a high volume of colonoscopies and have high ADRs.

There are other potential areas for quality improvement, as recommended by the American Society for Gastrointestinal Endoscopy/American College of Gastroenterology Task Force on Quality in Endoscopy, and new indicators are likely to appear as quality moves into the assessment of resection. Ultimately, the automatic calculation of ADR by natural language processing, linked endoscopy-pathology databases, and artificial intelligence programs should render this a moot issue.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


El Rahyel A, Vemulapalli KC, Lahr RE, Rex DK. Implications of stable or increasing adenoma detection rate on need for continuous measurement. Gastrointest Endosc 2021 Oct 20. (Epub ahead of print) (

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