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• W4295021408 abstract "Schottinger JE, Jensen CD, Ghai NR, et al. Association of physician adenoma detection rates with postcolonoscopy colorectal cancer. JAMA 2022;327:2114–2122. Colonoscopy plays an important role in the identification and resection of potentially premalignant lesions and is thus a key component of colorectal cancer (CRC) screening; however, its quality is highly variable between endoscopists. Colonoscopy quality indicators were developed to measure and manage this variability, with the most widely used being the adenoma detection rate (ADR). Schottinger et al performed a retrospective cohort study of 852,624 negative colonoscopies across 3 large U.S. health care regions to assess correlations between endoscopist ADR and post-colonoscopy CRC (PCCRC). Patients aged 50 to 75 years were included from 2011 to 2017. Negative colonoscopy occurred when CRC was not detected within the subsequent 6 months. The primary exposure was endoscopist ADR in the previous year—the percentage of screening-related colonoscopies in which ≥1 adenoma was detected. The primary outcome was PCCRC, defined as CRC occurring ≥6 months after a negative colonoscopy, with the secondary outcome being CRC-related mortality. A total of 852,624 negative colonoscopies performed by 383 physicians on 735,396 patients represented the final cohort. A total of 619 PCCRCs were detected along with 36 CRC-related deaths over a median per-patient follow-up period of 3.25 years. Significant associations between ADR and PCCRC were present across all study sites, with an overall hazard ratio (HR) per 1% ADR increase of 0.97 (95% confidence interval [CI] 0.96 to 0.98). Compared with colonoscopies performed by endoscopists with ADRs <28.3% (the median), those performed by endoscopists with ADRs ≥28.3% were significantly associated with lower risk of PCCRC, with a 7-year absolute risk difference of −12.2 per 10,000 cases (95% CI −10.3 to −13.4). Higher ADR was significantly associated with a lower risk of CRC-related mortality, with a HR per 1% ADR increase of 0.95 (95% CI 0.92 to 0.99). These results reaffirm messages from earlier seminal work reporting associations between ADR and PCCRC (N Engl J Med 2010;362:1795–1803, N Engl J Med 2014;370:1298–1306) but are more reflective of modern practices in which quality indicators are more widely measured and reported. In terms of limitations, more than 50% of procedures were for diagnostic indications; therefore, the relationship between ADR and PCCRC could be different in exclusively screening-related populations. However, patients with positive fecal immunochemical tests were included in the diagnostic cohort, likely mitigating this issue with generalizability. Second, sessile serrated lesions were included as part of ADR calculations in this study, which is not typical. Although they are important precursors to CRC, there is established variation in histologic differentiation of these lesions from hyperplastic polyps (Gastroenterology 2019;157:949–966.e4), which adds a degree of uncertainty to the results. Finally, the findings do not consider the new recommendations for starting CRC screening at age 45 years rather than 50 years (JAMA 2021;325:1965–1977). Nevertheless, these findings stress the importance of measuring and reporting ADR and of endoscopist feedback, given its demonstrated associations with ADR improvements (Gastrointest Endosc 2020;92:1030–1040.e9)." @default.
• W4295021408 created "2022-09-09" @default.
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• W4295021408 date "2022-12-01" @default.
• W4295021408 modified "2023-10-14" @default.
• W4295021408 title "Endoscopist Adenoma Detection Rates and Their Correlation With Postcolonoscopy Colorectal Cancer" @default.
• W4295021408 doi "https://doi.org/10.1053/j.gastro.2022.09.004" @default.
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