Quality Metrics and Indicators in Colonoscopy

Colonoscopy is the preferred method for colorectal cancer screening. However, despite significant advances, the examination remains subject to limitations and variability amongst different practitioners. This calls for the need for objective quality indicators to ensure the optimal use of the modality. Three major priority quality measures have been identified that include adenoma detection rate (ADR), cecal intubation, and adherence to surveillance guidelines. ADR is the best-studied metric correlating with outcomes including post-colonoscopy colon cancer, but has inherent limitations such as the potential for corruptibility. Other important quality indicators include the quality of bowel preparation and colonoscopy withdrawal time. All these quality measures are interrelated and an improvement in any of them would help in increasing the power of colonoscopy as a screening tool, as well as decreasing its economic burden and potentially improving adherence to screening guidelines.