Bernard Denis1, Erik André Sauleau2, Isabelle Gendre3, Catherine Exbrayat4, Christine Piette5, Vincent Dancourt6, Yvon Foll7, Hamou Ait Hadad8, Laurent Bailly9, Philippe Perrin3. 1. Department of Gastroenterology, Pasteur Hospital, 39 avenue de la Liberté, Colmar, France; Association for Colorectal Cancer Screening in Alsace (ADECA Alsace), 122 rue de Logelbach, Colmar, France. Electronic address: bernard.denis@ch-colmar.fr. 2. Biostatistics Laboratory, Medicine University, Strasbourg, France. 3. Association for Colorectal Cancer Screening in Alsace (ADECA Alsace), 122 rue de Logelbach, Colmar, France. 4. Association for Cancer Screening in Isère (ODLC 38), 19 chemin de la Dhuy - Maupertuis, Meylan, France. 5. Association for Cancer Screening in Ille-et-Vilaine (ADECI 35), 7 rue Armand Herpin Lacroix, Rennes, France. 6. Association for Cancer Screening in Côte d'Or (ADECA 21), 16 rue Nodot, Dijon, France. 7. Association for Cancer Screening in Finistère (ADEC 29), 1 avenue du Baron Lacrosse, Brest, France. 8. Association for Cancer Screening in Essonne (ADMC 91), centre médical de Bligny, Courtaboeuf, France. 9. Association for Cancer Screening in Alpes-Maritimes (APREMAS), 227 avenue de la lanterne, Nice, France.
Abstract
BACKGROUND: Measuring adenoma detection is a priority in the quality improvement process for colonoscopy. Our aim was (1) to determine the most appropriate quality indicators to assess the neoplasia yield of colonoscopy and (2) to establish benchmark rates for the French colorectal cancer screening programme. METHODS: Retrospective study of all colonoscopies performed in average-risk asymptomatic people aged 50-74 years after a positive guaiac faecal occult blood test in eight administrative areas of the French population-based programme. RESULTS: We analysed 42,817 colonoscopies performed by 316 gastroenterologists. Endoscopists who had an adenoma detection rate around the benchmark of 35% had a mean number of adenomas per colonoscopy varying between 0.36 and 0.98. 13.9% of endoscopists had a mean number of adenomas above the benchmark of 0.6 and an adenoma detection rate below the benchmark of 35%, or inversely. Correlation was excellent between mean numbers of adenomas and polyps per colonoscopy (Pearson coefficient r=0.90, p<0.0001), better than correlation between mean number of adenomas and adenoma detection rate (r=0.84, p=0.01). CONCLUSION: The mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy. Benchmark could be established at 0.6 in the French programme.
BACKGROUND: Measuring adenoma detection is a priority in the quality improvement process for colonoscopy. Our aim was (1) to determine the most appropriate quality indicators to assess the neoplasia yield of colonoscopy and (2) to establish benchmark rates for the French colorectal cancer screening programme. METHODS: Retrospective study of all colonoscopies performed in average-risk asymptomatic people aged 50-74 years after a positive guaiac faecal occult blood test in eight administrative areas of the French population-based programme. RESULTS: We analysed 42,817 colonoscopies performed by 316 gastroenterologists. Endoscopists who had an adenoma detection rate around the benchmark of 35% had a mean number of adenomas per colonoscopy varying between 0.36 and 0.98. 13.9% of endoscopists had a mean number of adenomas above the benchmark of 0.6 and an adenoma detection rate below the benchmark of 35%, or inversely. Correlation was excellent between mean numbers of adenomas and polyps per colonoscopy (Pearson coefficient r=0.90, p<0.0001), better than correlation between mean number of adenomas and adenoma detection rate (r=0.84, p=0.01). CONCLUSION: The mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy. Benchmark could be established at 0.6 in the French programme.
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