• Pieter H A Wisse, Nicole S Erler, Sybrand Y de Boer, Bert den Hartog, Marco Oudkerk Pool, Jochim S Terhaar Sive Droste, Claudia Verveer, Gerrit A Meijer, Iris Lansdorp-Vogelaar, Ernst J Kuipers, Evelien Dekker, and SpaanderManon C WMCW0000-0002-9103-9757Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.H.A.W., E.J.K., M.C.W.S.)..
• Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.H.A.W., E.J.K., M.C.W.S.).
• Ann. Intern. Med. 2022 Oct 1; 175 (10): 1366-1373.

BackgroundThe adenoma detection rate (ADR) is an essential quality indicator for endoscopists performing colonoscopies for colorectal cancer (CRC) screening as it is associated with postcolonoscopy CRCs (PCCRCs). Currently, data on ADRs of endoscopists performing colonoscopies in fecal immunochemical testing (FIT)-based screening, the most common screening method, are scarce. Also, the association between the ADR and PCCRC has not been demonstrated in this setting.ObjectiveTo evaluate the association between the ADR and PCCRC risk in colonoscopies done after a positive FIT result.DesignPopulation-based cohort.SettingDutch, FIT-based, CRC screening program.ParticipantsPatients undergoing colonoscopy, done by accredited endoscopists, after a positive FIT result.MeasurementsQuality indicator performance and PCCRC incidence for colonoscopies in FIT-positive screenees were assessed. The PCCRCs were classified as interval, a cancer detected before recommended surveillance, or noninterval. The association between ADR and interval PCCRC was evaluated with a multivariable Cox regression model and PCCRC incidence was determined for different ADRs.Results362 endoscopists performed 116 360 colonoscopies with a median ADR of 67%. In total, 209 interval PCCRCs were identified. The ADR was associated with interval PCCRC, with an adjusted hazard ratio of 0.95 (95% CI, 0.92 to 0.97) per 1% increase in ADR. For every 1000 patients undergoing colonoscopy, the expected number of interval PCCRC diagnoses after 5 years was approximately 2 for endoscopists with ADRs of 70%, compared with more than 2.5, almost 3.5, and more than 4.5 for endoscopists with ADRs of 65%, 60%, and 55%, respectively.LimitationThe relative short duration of follow-up (median, 52 months) could be considered a limitation.ConclusionThe ADR of endoscopists is inversely associated with the risk for interval PCCRC in FIT-positive colonoscopies. Endoscopists performing colonoscopy in FIT-based screening should aim for markedly higher ADRs compared with primary colonoscopy.Primary Funding SourceNone.

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