Adenoma Detection Rate: Quality Indicators for Colonoscopy

There is considerable evidence that adenomatous polyps amenable to endoscopic resection predate cancer, and that polypectomy reduces the likelihood of cancer [7] . Therefore, colonoscopy is now the gold standard for CRC screening [8, 9] as it allows for the detection and removal of premalignant lesions. However, the effectiveness of colonoscopy is strongly associated with its quality. Among different quality indicators, the one most used is the adenoma detection rate (ADR), which is the percentage of average-risk patients for CRC who are found to have at least 1 adenoma or adenocarcinoma during a screening colonoscopy. There is compelling evidence supporting an inverse correlation between ADR and interval CRC (cancer found after a screening colonoscopy) [10] , which will lower future mortality from CRC. For this reason, ADR is increasingly being used to assess the quality of colonoscopy. In fact, quality measures can be used to maximize the effectiveness of colonoscopy by guiding consistent, highquality practice. As defined by the Center for Medicare and Medicaid Services, quality measures are tools that help us measure or quantify health-care processes that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care [11] . Quality measures are increasingly being used for reimbursement for colonoscopy and may also