Correlation between Surrogate Quality Indicators for Adenoma Detection Rate and Adenoma Miss Rate in Qualified Colonoscopy, CORE Study: KASID Multicenter Study

Abstract

Background/aims: The adenoma detection rate (ADR) does not reflect the complete detection of every adenoma during colonoscopy; thus, many surrogate indicators have been suggested. This study investigated whether the ADR and surrogate quality indicators reflect the adenoma miss rate (AMR) when performing qualified colonoscopy.

Methods: We performed a prospective, multicenter, cross-sectional study of asymptomatic examinees aged 50 to 75 years who underwent back-to-back screening colonoscopies by eight endoscopists. The ADR and surrogate quality indicators, including polyp detection rate, total number of adenomas per colonoscopy, additional adenomas found after the first adenoma per colonoscopy (ADR-Plus), and total number of adenomas per positive participant, were calculated for the prediction of AMR.

Results: A total of 371 back-to-back colonoscopies were performed. There was a significant difference in ADRs (range, 44% to 75.4%; p=0.024), polyp detection rates (range, 56% to 86.9%; p=0.008) and adenomas per positive participants (range, 1.19 to 2.30; p=0.038), and a tendency of a difference in adenomas per colonoscopy (range, 0.62 to 1.31; p=0.051) and ADR-Plus (range, 0.13 to 0.70; p=0.054) among the endoscopists. The overall AMR was 20.1%, and AMRs were not different (range, 13.9 to 28.6; p>0.05) among the endoscopists. No quality indicators were significantly correlated with AMR. The number of adenomas found during the first colonoscopy was an independent factor for increased AMR (odds ratio, 1.79; p<0.001).

Conclusions: The colonoscopy quality indicators were significantly different among high-ADR endoscopists, and none of the quality indicators reflected the AMR of good quality colonoscopy performances. The only factor influencing AMR was the number of adenomas detected during colonoscopy.

Keywords: Adenoma; Colonoscopy; Miss rate; Quality indicator.

Fig. 1

Study flow diagram. Eight endoscopists from five institutions performed screening colonoscopies from July 2018 to June 2020. A total of 742 back-to-back colonoscopies were performed in 371 examinees.

Fig. 2

Numerical distribution of colonoscopy quality indicators of eight endoscopists. There was a significant correlation between ADR and PDR (r=0.826, p=0.011), but there was no significant correlation between quality indicators and AMR (AMR and ADR: r=0.476, p=0.243; AMR and APC: r=–0.095, p=0.840; AMR and PDR: r=0.204, p=0.629; AMR and APP: r=–0.375, p=0.389; AMR and ADR-P: r=–0.262, p=0.536). ADR, adenoma detection rate; PDR, polyp detection rate; APC, adenomas per colonoscopy; ADR-P, additional adenomas found after the first adenoma per colonoscopy; APP, total number of adenomas per positive participant; AMR, adenoma miss rate; r, rho.