Enhancing the adenoma detection rate in colorectal cancer screening: adenomas per colonoscopy as an additional quality metric

Aims The aims of this study were toassess the association between the adenoma detection rate (ADR) and the adenomas per colonoscopy (APC) metrics in colorectal cancer screening and to explore factors influenciating each of these indicators.

Methods This retrospective, single-center study analyzed total screening colonoscopies conducted on 50 years old or more patients, over a period of 18 months (from April 2022 to September 2023) and their corresponding histological reports. The APC is calculated by dividing the total number of detected adenomas by the number of colonoscopies performed. Colonoscopies with at least one colonic segment with less than 2 points on the Boston Bowel Preparation Scale (BBPs) were excluded. Statistical analysis was performed using SPSS v29.0.

Results 502 total colonoscopies were included. ADR was 41.7% and APC was 76.5%. The number of adenomas per colonoscopy ranged from 0 to 11 adenomas. There was a positive statistically significant association between the ADR and the APC (β=0.6, p<0.001). No statistically significant difference was found in the average age between patients with and without adenomas (p>0.05), nor a correlation between age and the number of APC (p>0.05). Men were 2.1 times more likely to have at least one adenoma (p<0.05) and the average number of adenomas per colonoscopy was statistically significant higher in men (p<0.05). The BBPS score was not associated with the detection of at least one adenoma or to the total number of adenomas per colonoscopy (p>0.05). The average withdrawal time was higher in patients with adenomas (p<0.05), and there was a positive, statistically significant, moderate correlation between withdrawal time and the number of APC (r=0.5; p<0.001). No association was found between the colonoscopy schedule, endoscopist fatigue or experience and the presence of at least one adenoma (p>0.05). The average number of adenomas per colonoscopy was also not statistically significantly different among the previously mentioned groups (p>0.05).

Conclusions Our study confirmed a significant association between the ADR and the APC, encouraging the use of APC as a complementary metric in colorectal cancer screening. Influencing factors were similar between the two indicators. While gender and withdrawal time significantly influenced adenoma detection and the number of adenomas detected per colonoscopy, with men and longer procedures showing higher ADR and APC rates, other factors such as age, bowel preparation quality, and procedural variables showed no significant impact.

Publication History

Article published online:
27 March 2025