ADENOMA DETECTION RATE IN COLONOSCOPY:A KEY QUALITY INDICATOR AND ITS CLINICAL SIGNIFICANCE

Abstract

The adenoma detection rate (ADR), defined as the proportion of cases in which at least one adenoma was detected during colonoscopy, is among the most important quality indicators for colonoscopy. The concept of ADR was introduced in the early 2000s in the United States and Europe, with subsequent studies demonstrating its significant impact on clinical outcomes, including the incidence and mortality of post-colonoscopy colorectal cancer. In 2015, the recommended level in the United States was 25% (for first-time screening colonoscopies in individuals aged ≥ 50 years); however, the revised 2024 US recommendation has increased the target to 35% (for screening, surveillance, and diagnostic colonoscopies for individuals aged ≥ 45 years). Besides basic factors, such as appropriate bowel preparation and sufficient observation time, the introduction of new technologies, such as image-enhanced endoscopy and artificial intelligence-assisted systems, is useful for improving ADR. In Japan, systems for monitoring ADR remain underdeveloped, highlighting the need for improvement in this area.