The analysis of multilevel factors affecting adenoma detection rates for colonoscopies: a large-scale retrospective study.

Background Adenoma detection rate (ADR) is a validated primary quality indicator for colonoscopy procedures. However, there is growing concern over the variability associated with ADR indicators. Currently, the factors that influence ADRs are not well understood. Aims In this large-scale retrospective study, the impact of multilevel factors on the quality of ADR-based colonoscopy was assessed. Methods A total of 10,788 patients, who underwent colonoscopies performed by 21 endoscopists between January 2019 and December 2019, were retrospectively enrolled in this study. Multilevel factors, including patient-, procedure-, and endoscopist-level characteristics were analyzed to determine their relationship with ADR. Results The overall ADR was 20.21% and ranged from 11.4 to 32.8%. Multivariate regression analysis revealed that higher ADRs were strongly correlated with the following multilevel factors: patient age per stage (OR 1.645; 95% CI 1.577-1.717), male gender (OR 1.959; 95% CI 1.772-2.166), sedation (OR 1.402; 95% CI 1.246-1.578), single examiner colonoscopy (OR 1.330; 95% CI 1.194-1.482) and senior level endoscopists (OR 1.609; 95% CI 1.449-1.787). Conclusion The ADR is positively correlated with senior level endoscopists and single examiner colonoscopies in patients under sedation. As such, these procedure- and endoscopist-level characteristics are important considerations to improve the colonoscopy quality.