Comparison of quality performance metrics in screening and surveillance colonoscopy: a single-center experience

TL;DR

This study compares quality metrics in screening and surveillance colonoscopies, finding higher adenoma detection rates in surveillance procedures.

Contribution

The study identifies higher quality metrics in surveillance colonoscopies and suggests higher benchmarks for these procedures.

Findings

Surveillance colonoscopies had a significantly higher adenoma detection rate than screening colonoscopies.

Polyp detection rate and right-sided polyp detection rate strongly correlated with adenoma detection rate in surveillance procedures.

Quality metrics in surveillance colonoscopies were higher despite similar withdrawal times to screening procedures.

Abstract

Screening colonoscopy guidelines recommend a minimum adenoma detection rate (ADR) of 35%. There are no established benchmarks for surveillance colonoscopies, and data surrounding the utility of other quality metrics are limited. We aimed to define the relationship between ADR and alternative quality measures in the setting of screening and surveillance colonoscopies and to determine whether validated screening quality benchmarks can be extrapolated to surveillance procedures.

A retrospective review of outpatient screening and surveillance colonoscopies at a tertiary health center was performed. ADR, adenomas per colonoscopy, adenomas per positive participant, polyp detection rate, right-sided polyp detection rate, and colonoscopy withdrawal times (CWTs) were analyzed for screening and surveillance colonoscopies.

In total, 2646 procedures (1884 screening, 762 surveillance) were analyzed. Surveillance ADR (CADR) was higher than screening ADR (65.6% ± 0.02% vs 47.0% ± 0.01%; P < .001). All alternate quality measures except CWT were higher in surveillance procedures. Among surveillance procedures, there was a strong correlation between CADR and polyp detection rate (r = .956, P < .01) and right-sided polyp detection rate (r = .771, P = .003); correlations between CADR and other alternate quality measures were not significant.

Colonoscopy quality measures were significantly higher in surveillance procedures compared with screening procedures despite similar CWTs. Higher benchmarks should be considered to ensure quality surveillance colonoscopies.