Polypectomy rate as a quality measure for colonoscopy

Background: The adenoma detection rate (ADR) has been proposed as a robust quality indicator for colonoscopy, but it is cumbersome to calculate and not available at the time of colonoscopy.

Objective: To determine whether endoscopists' polypectomy rates (PRs) correlate with their ADRs and to calculate benchmark PRs that correlate with benchmark ADRs.

Design: Retrospective study.

Setting: University and Veterans Affairs endoscopy units in Portland, Oregon.

Subjects: Fifteen endoscopists and their patients.

Main outcome measurements: Proportion of patients with any adenoma and any polyp removed; correlation between ADRs and PRs.

Results: Fifteen endoscopists performed 2706 average-risk screening colonoscopies during the study. There was variation in the ADR for men (15.4%-44.7%) and women (6.1%-25.8%) and in the PRs for men (17.9%-66.0%) and women (11.3%-43.1%). Endoscopists' PRs correlated well with their ADRs (r(s) = 0.86, P < .001). To attain the established benchmark ADRs for men (25%) and women (15%), endoscopists needed PRs of 40% and 30%, respectively. Endoscopists attaining the benchmark PRs had a higher ADR among men (32.1% vs 18.4%, P < .001) and a higher ADR among women (21.0% vs 9.8%, P = .01) than those who did not.

Limitations: Study endoscopists' approach to polypectomy may differ from that of endoscopists in other settings.

Conclusions: The PR is a useful quality measure with a high degree of correlation with the ADR.