PDR or ADR as a quality indicator for colonoscopy.

Interval (missed) cancers and lower-than-expected mortality reduction of proximal colon cancers after screening colonoscopy drew attention to quality indicators. Small proximal polyps (prone to be advanced neoplasms) missed by colonoscopy are possible contributing factors. In this issue of AJG, the subject of polyp detection rates (PDRs) and adenoma detection rates (ADRs) in the proximal and distal colon is discussed by one group of investigators to address the issue of monitoring performance and to achieve improvement. The authors observed that these two parameters correlated well in segments proximal to the splenic flexure, but not in the left colon. They suggested that caution should be exercised when using PDR as a surrogate for ADR if data from the rectum and sigmoid were included. Avoidance of missed lesions at the time of colonoscopy may require new adjunct measures to enhance ADR. The impact of new adjunct measures on ADR is mixed. In contrast to water immersion, water exchange during insertion has consistently increased ADR during withdrawal inspection. Water exchange may be a suitable alternative platform to replace insertion by air insufflation in the evaluation of new adjunct measures of quality improvement to increase ADR. Payment reforms may be necessary to bring about inclusion of ADR reporting for monitoring of quality performance.