Proposal of high-risk adenoma detection rate as an impactful, complementary quality indicator of colonoscopy

Vaibhav Wadhwa, Yash Jobanputra, Haider Al Taii, Prashanthi N. Thota, Rocio Lopez, Suryakanth R. Gurudu, Madhusudhan R. Sanaka

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background and aims: Adenoma detection rate (ADR), a validated quality indicator (QI) of colonoscopy, does not take into account risk stratification of adenomas. Low-risk adenomas are not associated with a significantly increased risk of future colorectal cancer (CRC). On the other hand, high-risk adenomas (HRA) are associated with up to six fold higher risk of future CRC. Therefore, HRA detection rate (HR-ADR) as a QI in addition to ADR may further enhance the efficacy of screening colonoscopy. Our aim was to calculate ADR and HR-ADR in a large cohort of average risk screening colonoscopy patients and propose HR-ADR which correlates with current threshold ADR. Methods: This is a retrospective chart review of all colonoscopies performed in patients aged ≥ 50 years at our institution between 2012 and 2014. Average risk patients who had complete colonoscopy with good, excellent and adequate bowel preparation were included. Overall and gender-specific ADR and HR-ADR were calculated. HR-ADR was defined as proportion of colonoscopies with HRA. Results: Among 4158 colonoscopies included, ADR was 26.4 ± 10.9% overall, 32.7 ± 14.5% in men, and 22.1 ± 12.6% in women. HR-ADR was 8.0 ± 5.7% overall, 10.2 ± 8.6% in men, and 6.1 ± 6% in women. There was only moderate correlation between ADR and HR-ADR [r = 0.57 (0.40–0.70)]. HR-ADR corresponding with minimum threshold ADR of 30% in men and 20% in women were calculated to be 7% in men and 4% in women. Conclusions: HR-ADR correlates only moderately with ADR. Based on the current threshold ADRs, we propose a benchmark HR-ADR of 7% in men and 4% in women as complementary QI to ADR.

Original languageEnglish (US)
Pages (from-to)325-331
Number of pages7
JournalSurgical Endoscopy
Issue number1
StatePublished - Jan 1 2020
Externally publishedYes


  • Adenoma detection
  • Colon polyps
  • Colonoscopy
  • High risk
  • Quality indicators
  • Screening

ASJC Scopus subject areas

  • Surgery


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