SNAPSHOTS FROM THE
Douglas K. Rex, MD, AGAF, is professor of medicine, division of
gastroenterology/hepatology, at Indiana University, Indianapolis.
He has no relevant conflicts of interest.
The U.S. Multi-Society Task Force on Colorectal Cancer proposed the adenoma detec- tion rate (ADR) as a colonos- copy quality measure in 2002. The rationale for a new measure was emerging evidence of highly variable adenoma detection and
cancer prevention among colonoscopists. Highly variable performance,
consistently verified in subsequent
studies, casts a pall of severe operator dependence over colonoscopy. In
landmark studies from Kaminski et
al. and Corley et al. in 2010 and 2014,
respectively, it was shown that doctors
with higher ADRs provide patients
with much greater protection against
interval colorectal cancer (CRC).
A huge body of work investigated
whether colonoscopists can improve
ADRs. After initial setbacks, methods of
ADR improvement have been convincingly demonstrated.
Now Kaminski and colleagues from
Poland have delivered a second land-
mark study, demonstrating for the first
time that improving ADR prevents CRCs.
We now have strong evidence that ADR
predicts the level of cancer prevention,
that ADR improvement is achievable,
and that improving ADR further prevents CRCs and CRC deaths. Thanks
to this study, ADR has come full circle.
Measurement of and improvement in
detection is now a fully validated concept that is essential to modern colonoscopy. In 2017, ADR measurement is
mandatory for all practicing colonoscopists who are serious about CRC prevention. The tools to improve ADR that are
widely accepted include ADR measurement and reporting, split or same-day
preparations, lesion recognition and
optimal technique, high-definition imaging, double examination (particularly
for the right colon), patient rotation
during withdrawal, chromoendoscopy,
mucosal exposure devices (caps, cuffs,
balloons, etc.), and water exchange.
Tools for ADR improvement that are
emerging or under study are brighter
forms of electronic chromoendoscopy,
and videorecording. n
Key clinical point: An improved
adenoma detection rate was associated with a significantly reduced
risk of interval colorectal cancer
and subsequent death.
Major finding: Adjusted hazard
ratios were 0.6 for developing ICRC
(95% CI, 0.5-0.9; P = .006) and 0.50
for dying of ICRC (95% CI, 0.3-0.95;
P = .04).
Data source: A prospective registry study of 294 endoscopists and
146,860 individuals who underwent
screening colonoscopy as part of
a national screening program between 2004 and 2008.
Disclosures: Funders included the
Foundation of Polish Science, the
Innovative Economy Operational
Programme, the Polish Foundation
of Gastroenterology, the Polish Ministry of Health, and the Polish Ministry of Science and Higher Education.
The investigators reported having
no relevant conflicts of interest.
Improved Adenoma Detection Rate Found Protective Against Interval Cancers, Death
July 2017 Gastroenterology (doi: 10.1053/ j.gastro.2017.04.006)