May 17th, 2011

How good a colonoscopist are you?

I have noticed that we all think we are the best endoscopist around (in my case, that is indeed true!). However, we really never measured colonoscopy skill as a “patient-centered” metric and instead often use speed, efficiency, sedation needs, etc. when judging our colleagues. What is more important than these measures, however, is whether we find and remove adenomas, thereby preventing colon cancer downstream in our patients.

A number of surrogate markers for quality colonoscopy and polyp detection have been used in the past, including scope-withdrawal time from the cecum. But the one measure that has been the best predictor of quality is an endoscopist’s ADR (adenoma detection rate). In fact, this is the most reliable quality measure yet determined, and it may become the basis for being paid for these procedures in the not so distant future.

So I need to ask you:

1)      Do you know your ADR?

2)      Do you or does your group compare your ADR to other endoscopists within your endoscopy unit or practice?

3)      Is there a program to increase ADR in low performers in your endoscopy unit?

4)      Do you use your ADR as a marketing tool?

5)      What is your take on the ADR as a quality measure?

I look forward to hearing from you on this topic!

One Response to “How good a colonoscopist are you?”

  1. William Schindler D.O. says:

    1) yes
    2) yes
    3) being discussed
    4) no–work for Kaiser
    5) i think it is a reasonable tool, though cannot be applied in my opinion in the same manner for patient’s undergoing a first time screen comred to those in surveillance- i have harbored doubts of benefit in removing adenomas in the 3-4 mm range but given the recommeded lengthy intervals between procedures, i do.this anyway which certainly can make for some longer procedues as we study with a “fine toothed comb” and there still is a miss rate

Gastroenterology Research: Author M. Brian Fennerty, M.D.

M. Brian Fennerty, MD


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