The analysis of multilevel factors affecting adenoma detection rates for colonoscopies: a large-scale retrospective study.

BACKGROUND

Adenoma detection rate (ADR) is a validated primary quality indicator for colonoscopy procedures. However, there is growing concern over the variability associated with ADR indicators. Currently, the factors that influence ADRs are not well understood.

AIMS: In this large-scale retrospective study, the impact of multilevel factors on the quality of ADR-based colonoscopy was assessed.

METHODS

A total of 10,788 patients, who underwent colonoscopies performed by 21 endoscopists between January 2019 and December 2019, were retrospectively enrolled in this study. Multilevel factors, including patient-, procedure-, and endoscopist-level characteristics were analyzed to determine their relationship with ADR.

RESULTS

The overall ADR was 20.21% and ranged from 11.4 to 32.8%. Multivariate regression analysis revealed that higher ADRs were strongly correlated with the following multilevel factors: patient age per stage (OR 1.645; 95% CI 1.577-1.717), male gender (OR 1.959; 95% CI 1.772-2.166), sedation (OR 1.402; 95% CI 1.246-1.578), single examiner colonoscopy (OR 1.330; 95% CI 1.194-1.482) and senior level endoscopists (OR 1.609; 95% CI 1.449-1.787).

CONCLUSION

The ADR is positively correlated with senior level endoscopists and single examiner colonoscopies in patients under sedation. As such, these procedure- and endoscopist-level characteristics are important considerations to improve the colonoscopy quality.