Seven Percent Are “One-and-Done” Colonoscopists
Douglas K. Rex, MD, FASGE reviewing Fedewa SA, et al. Endosc Int Open 2019 Nov.
“One and done” in colonoscopy refers to endoscopists who find one polyp, remove it, and then do not continue with meticulous clearing of the remainder of the colon. Most clinical studies suggest that one and done is rare, and there is a good correlation between the adenoma detection rate (ADR, a patient-based measure) and adenomas per colonoscopy (APC, a polyp-based measure). One and done can be suspected when the ADR is high and the corresponding APC is lower than expected.
In this study, the New Hampshire Colonoscopy Registry was used to evaluate 25,324 patients undergoing screening colonoscopy by 69 colonoscopists, with ADR dichotomized as ≥ or <20%. Total adenomas were expressed using the ADR-plus measure, which is the average number of adenomas in colonoscopies with >1 adenoma.
In the study, the median ADR was 22.9%, and the median ADR-plus was 1.5. Of the endoscopists with ADRs ≥20%, 5 (7.3%) had low ADR-plus values. None of the endoscopists with ADRs ≥25% had low ADR-plus values.
COMMENT
Overall, these results are consistent with the literature, in that they suggest that “one-and-done” behavior is very uncommon. This is encouraging reassurance about the good nature and intentions of nearly all endoscopists.
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.
Douglas K. Rex, MD, FASGE
CITATION(S)
Fedewa SA, Anderson JC, Robinson CM, et al. Prevalence of “one and done” in adenoma detection rates: results from the New Hampshire Colonoscopy Registry. Endosc Int Open 2019;07(11):E1344-E1354. (https://doi.org/10.1055/a-0895-5410)
