The proof is in the pudding: improving adenoma detection rates reduces interval colon cancer development

Screening colonoscopies save lives. A bold statement, certainly, but one borne out of extensive research and well-established data and one that we gastroenterologists believe is the main reason why we do colonoscopies each day. Studies demonstrate a significant decrease in the risk of developing as well as dying from colorectal cancer (CRC) in average-risk patients who undergo screening colonoscopy (1,2). The benefit of colonoscopy on CRC development and mortality comes from the ability to remove adenomatous polyps and, hence has arisen the importance of and focus on adenoma detection. Adenoma detection rate (ADR) is currently a quality measure for colonoscopy due its demonstrated inverse association with the development of CRC and mortality (3-6). Corley et al. demonstrated that each 1% increase in ADR is associated with a 3% decrease in the risk for CRC (7). This direct correlation has prompted study into how to improve an endoscopist’s ADR and what characteristics are associated with an endoscopists’ ADR. Feedback provided to endoscopists as well as periodic monitoring have resulted in improved ADR, especially in those endoscopists who, at baseline, were considered ‘low detectors’ (ADR <25%) (8-12).