Is longer better? A comparison of adenoma detection rates before and after the updated quality indicators for colonoscopies.

The 2024 ASGE-ACG guidelines raised performance thresholds for colonoscopy quality indicators and introduced sessile serrated lesion detection rate (SSLDR) as a new metric. We conducted a retrospective cohort study of 1973 screening colonoscopies at a single hospital system, comparing outcomes before (Group 1) and after (Group 2) implementation. Groups were demographically similar. Withdrawal time increased significantly after implementation (12.2 vs 13.0 min, p < 0.0001), as did cecal intubation rate (97.2% vs 98.6%, p = 0.0278). However, adenoma detection rate (52.2% vs 52.8%, p = 0.772) and SSLDR (12.7% vs 13.9%, p = 0.415) remained unchanged. Male sex and obesity were independently associated with higher adenoma detection. These findings suggest that in already high-performing endoscopy centers, stricter time-based metrics alone may be insufficient to meaningfully improve detection outcomes.