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

Abstract

Background and Aims

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.

Methods

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.

Results

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.

Conclusions

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.