Comments on "Adenoma detection rate by colonoscopy in real-world population-based studies: a systematic review and meta-analysis"

10.1055/a-2382-5795

We have read with great interest the article by Fernandes et al., recently published in Endoscopy [1]. This meta-analysis was conducted to evaluate the adenoma detection rate (ADR) and other quality indicators for colonoscopy through a systematic review and meta-analysis (31 studies; 3644561 subjects). The results showed the overall ADR was 26.5% (95%CI 23.3%–29.7%), the benchmark proposed by the European Society of Gastrointestinal Endoscopy (ESGE) being 25%. We would like to congratulate and thank the authors for writing such an insightful and novel article on this topic; however, we have some further thoughts regarding this topic.

First, regarding the 31 studies retrieved by Fernandes et al., we noted that the vast majority of these studies originated from high income countries (90.3%), with fewer from low income countries (9.7%); however, high income countries make up only a small proportion of the world's population. We conducted a subgroup analysis, which revealed that the pooled ADR in high income countries was 28% (95%CI 24%–31%), whereas in low income countries it was 17% (95%CI 0%–34%; P<0.05) ([Fig. 1]). Incidentally, we noticed that the authors indicated the ADR in the study of Hernandez et al. to be 27.5% in their table 2, while this data changed to 27% in the authors’ figure 2. After consulting the original text [2], we used 27.5% in our subsequent analysis. We suggest that, overall, the findings of this meta-analysis predominantly reflect the level in high income countries and may not accurately represent the global real-world scenario.

Fig. 1 Forest plot comparing adenoma detection rate (ADR) between high income countries and low income countries.

Furthermore, the study data spans a large timeframe (1998–2021). The ADR was first recognized as a core quality indicator in 2014, and has since gradually drawn increasing levels of attention [3]. Additionally, technologies like AI-aided high definition colonoscopy and quality improvement initiatives have become increasingly prevalent, significantly enhancing the ADR [4] [5]. The inclusion by Fernandes et al. of the earlier prospective studies might therefore have led to an underestimation of the overall ADR.

Publikationsverlauf

Artikel online veröffentlicht:
28. Oktober 2025

• References

• 1 Fernandes C, Estevinho M, Marques Cruz M. et al. Adenoma detection rate by colonoscopy in real-world population-based studies: a systematic review and meta-analysis. Endoscopy 2025; 57: 49-61
• 2 Hernandez L, Deas TM, Catalano MF. et al. Longitudinal assessment of colonoscopy quality indicators: a report from the Gastroenterology Practice Management Group. Gastrointest Endosc 2014; 80: 835-411
• 3 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. NEJM 2014; 370: 1298-1306
• 4 Keswani RN, Yadlapati R, Gleason KM. et al. Physician report cards and implementing standards of practice are both significantly associated with improved screening colonoscopy quality. Am J Gastroenterol 2015; 110: 1134-1139
• 5 Repici A, Badalamenti M, Maselli R. et al. Efficacy of real-time computer-aided detection of colorectal neoplasia in a randomized trial. Gastroenterology 2020; 159: 512-520.e7