Reporting of Adenoma Detection by Segment: A Proposed New Quality Metric for Colonoscopy

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2023-01-01 DOI:10.1016/j.tige.2022.10.006

Lawrence R. Kosinski , David Lieberman , Leanne Metcalfe , Lan Vu

{"title":"Reporting of Adenoma Detection by Segment: A Proposed New Quality Metric for Colonoscopy","authors":"Lawrence R. Kosinski , David Lieberman , Leanne Metcalfe , Lan Vu","doi":"10.1016/j.tige.2022.10.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and Aims</h3><p>The adenoma<span> detection rate (ADR), is a key quality metric for colonoscopy, but it might fail to measure differences in adenoma detection in different parts of the colon. Because many post-colonoscopy cancers arise in the proximal colon, differences in the ADR of proximal vs distal adenomas could be clinically important. Our aim was to determine the feasibility of measuring ADR for both the proximal and distal colon and to understand differences based on age, sex, and race.</span></p></div><div><h3>Methods</h3><p>We queried a large claims database (Health Care Service Corporation) to screen colonoscopies from 2016-2018 to determine the location and pathology of detected polyps. We measured the ADR in both the proximal (P-ADR) and distal (D-ADR) colon to determine differences in the ratio of P-ADR vs D-ADR by age, sex, and race.</p></div><div><h3>Results</h3><p>The cohort included 93,163 women and 89,132 men. A progressive increase in both P-ADR and D-ADR occurs with advancing age, with the P-ADR/D-ADR ratio rising from 1.2 in patients under 40 years of age to 2.65 in patients age 75 and older, in both men and women. This ratio is affected by the experience of the endoscopist. A higher volume of procedures is directly related to higher polyp detection, specifically the P-ADR.</p></div><div><h3>Conclusion</h3><p>As age advances, there is an increasing predominance of proximal adenomas relative to distal adenomas in both men and women, in all races. With appropriate coding, it is feasible to measure the ADR for the proximal and distal colon. Measurement of P-ADR could be an important new quality metric.</p></div>","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2590030722000824","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and Aims

The adenoma detection rate (ADR), is a key quality metric for colonoscopy, but it might fail to measure differences in adenoma detection in different parts of the colon. Because many post-colonoscopy cancers arise in the proximal colon, differences in the ADR of proximal vs distal adenomas could be clinically important. Our aim was to determine the feasibility of measuring ADR for both the proximal and distal colon and to understand differences based on age, sex, and race.

Methods

We queried a large claims database (Health Care Service Corporation) to screen colonoscopies from 2016-2018 to determine the location and pathology of detected polyps. We measured the ADR in both the proximal (P-ADR) and distal (D-ADR) colon to determine differences in the ratio of P-ADR vs D-ADR by age, sex, and race.

Results

The cohort included 93,163 women and 89,132 men. A progressive increase in both P-ADR and D-ADR occurs with advancing age, with the P-ADR/D-ADR ratio rising from 1.2 in patients under 40 years of age to 2.65 in patients age 75 and older, in both men and women. This ratio is affected by the experience of the endoscopist. A higher volume of procedures is directly related to higher polyp detection, specifically the P-ADR.

Conclusion

As age advances, there is an increasing predominance of proximal adenomas relative to distal adenomas in both men and women, in all races. With appropriate coding, it is feasible to measure the ADR for the proximal and distal colon. Measurement of P-ADR could be an important new quality metric.

查看原文本刊更多论文

腺瘤分段检测报告:一种新的结肠镜检查质量指标

背景和目的腺瘤检出率（ADR）是结肠镜检查的一个关键质量指标，但它可能无法衡量结肠不同部位腺瘤检出率的差异。由于许多结肠镜检查后癌症发生在近端结肠，近端腺瘤和远端腺瘤ADR的差异可能具有重要的临床意义。我们的目的是确定测量近端和远端结肠ADR的可行性，并了解基于年龄、性别和种族的差异。方法我们查询了一个大型索赔数据库（卫生保健服务公司），对2016-2018年的结肠镜检查进行筛查，以确定检测到的息肉的位置和病理。我们测量了近端（P-ADR）和远端（D-ADR）结肠的ADR，以确定年龄、性别和种族的P-ADR与D-ADR比率的差异。结果队列包括93163名女性和89132名男性。P-ADR和D-ADR都随着年龄的增长而逐渐增加，男性和女性的P-ADR/D-ADR比率从40岁以下患者的1.2上升到75岁及以上患者的2.65。这个比例受内窥镜医生经验的影响。较高的手术量与较高的息肉检测直接相关，特别是P-ADR。结论随着年龄的增长，在所有种族的男性和女性中，近端腺瘤的发病率都高于远端腺瘤。通过适当的编码，测量近端和远端结肠的ADR是可行的。P-ADR的测量可能是一个重要的新的质量指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.