The mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy: a population-based cohort study.
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).


CONCLUSIONS
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.
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.
Bernard
B
Denis
Biostatistics Laboratory, Medicine University, Strasbourg, France.
Erik André
EA
Sauleau
Association for Colorectal Cancer Screening in Alsace (ADECA Alsace), 122 rue de Logelbach, Colmar, France.
Isabelle
I
Gendre
Association for Cancer Screening in Isère (ODLC 38), 19 chemin de la Dhuy - Maupertuis, Meylan, France.
Catherine
C
Exbrayat
Association for Cancer Screening in Ille-et-Vilaine (ADECI 35), 7 rue Armand Herpin Lacroix, Rennes, France.
Christine
C
Piette
Association for Cancer Screening in Côte d'Or (ADECA 21), 16 rue Nodot, Dijon, France.
Vincent
V
Dancourt
Association for Cancer Screening in Finistère (ADEC 29), 1 avenue du Baron Lacrosse, Brest, France.
Yvon
Y
Foll
Association for Cancer Screening in Essonne (ADMC 91), centre médical de Bligny, Courtaboeuf, France.
Hamou
H
Ait Hadad
Association for Cancer Screening in Alpes-Maritimes (APREMAS), 227 avenue de la lanterne, Nice, France.
Laurent
L
Bailly
Association for Colorectal Cancer Screening in Alsace (ADECA Alsace), 122 rue de Logelbach, Colmar, France.
Philippe
P
Perrin
D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D019985:Benchmarking; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000473:pathology; D015331:Cohort Studies; D003111:Colonic Polyps / Q000175:diagnosis* / Q000473:pathology; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement; D012189:Retrospective Studies
Adenoma; Colonoscopy; Colorectal neoplasms; Diagnosis; Mass screening; Occult blood; Quality improvement; Standards