Adenoma detection rate is necessary but insufficient for distinguishing high versus low endoscopist performance

Abstract

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 Limitations External generalizability, nonrandomized study. Conclusion We found minimal ADR differences between the 2 endoscopist groups, but substantial differences in total adenomas;…