Increased adenoma detection rate may significantly reduce post-colonoscopy colorectal cancer risk

Introduction The incidence of colorectal cancer (CRC) continues to rise, making it the third most common form of cancer in Europe. Early diagnosis of this disease is critical for successful treatment and prevention, making the Italian Colorectal Cancer screening program (ICCS) an invaluable resource in the fight against CRC. The ICCS recently conducted a cohort study that found an inverse association between endoscopists' proficiency, as measured by the adenoma detection rate (ADR), and post-colonoscopy colorectal cancer (PCCRC) risk. The study, published in Annals of Internal Medicine, has indicated that targeting low-performing endoscopists with measures to increase ADR could significantly reduce PCCRC risk. Study Summary The ICCS study included more than 49,000 colonoscopies performed between 2004 and 2017 in Italy. The study used a retrospective analysis to evaluate endoscopists' proficiency, as measured by their ADR, and its association with PCCRC risk. Endoscopists with an ADR of 19.0% or greater were considered high performing, while those with an ADR of less than 19.0% were considered low performing. The study found that overall, PCCRC incidence was higher in the low-performing group (0.51%) than the high-performing group (0.33%). After adjusting for other factors, the risk of PCCRC was significantly associated with endoscopists' performance and the difference in risk was consistent across all levels of ADR. Additionally, the study identified that targeting only those endoscopists with the lowest ADR (less than 13.0%) could reduce PCCRC risk by up to 40%. Review of Literature Previous studies have found an association between endoscopists' performance measured by ADR and PCCRC risk. A study conducted in the Netherlands identified that colonoscopies performed by lower-performing endoscopists (ADR<20.0%) were associated with a higher risk of PCCRC than those performed by higher-performing endoscopists (ADR≥20.0%). Similarly, a study conducted in the United Kingdom found that endoscopists with a lower ADR (15.9-19.9%) had a higher risk of PCCRC than those with a higher ADR (20.0-24.9%). These studies, as well as the current ICCS study, suggest that targeting measures to increase ADR among low-performing endoscopists could be an effective way to reduce PCCRC risk. However, there is a need for further research to evaluate the efficacy of different interventions, such as education programs and quality improvement measures, to improve endoscopists' performance. Conclusion The ICCS study is the first to evaluate the association between endoscopists' ADR and PCCRC risk and to suggest that targeting only low-performing endoscopists with measures to increase ADR may significantly reduce PCCRC risk. Previous studies have identified a similar association between ADR and PCCRC risk, but none have been able to suggest a specific and measurable course of action. The findings of this study indicate that targeting low-performing endoscopists with measures to increase their ADR could be an effective way to reduce PCCRC risk. More research is needed to identify and evaluate the efficacy of different interventions that could be used to improve endoscopists' performance.

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