A Measure to Combat “One and Done”

The adenoma detection rate (ADR) is currently the primary measure of quality of mucosal inspection during colonoscopy and has been shown to be a predictor of interval cancers (N Engl J Med 2010; 362:1795). However, the ADR does not account for identification of multiple adenomas during colonoscopy, thereby possibly encouraging a “one and done” approach in which endoscopists might carry out less careful examination of the colon after the first polyp or adenoma is detected. This might be partially attributable to reimbursement structures for colonoscopy that pay a flat fee for polypectomy regardless of the number of polypectomies per procedure.

In the current study, investigators calculate and compare several alternative measures of adenoma de…