bowel preparation has been shown in randomized trials to improve
ADR," says Dr. Rex. This is a fundamental part of achieving high-quali-
ty colonoscopy, but for whatever reason, there are still a fair number
of people who don't appreciate the importance of using split prep,
adds Dr. Rex.
3. High definition isn't optional.
The need for a high-definition
endoscope isn't up for debate if you're serious about ADR. "In this day
and age, high-quality colonoscopy necessitates using HD scopes," says
Dr. Keswani. "They detect adenomas at a higher rate than the older
scopes." Dr. Rex agrees — and even takes it a step further. "The criti-
cal thing is that high-definition resolution," he says. "You can compen-
sate for having a 170-degree view instead of a 330-degree view by
using excellent technique, but you cannot compensate for poor reso-
lution. If you only have standard definition or there's some impair-
ment of the image resolution, you simply can't compensate for that."
Beyond the 'basement'
High-quality colonoscopy that translates to above average ADRs essen-
tially comes down to equipping skilled, knowledgeable endoscopists
with high-definition scopes, measuring and benchmarking their per-
formance, and ensuring that all patients use split-bowel preparations.
If you do these things, there's no reason all your GI docs won't meet
the minimum 25% adenoma detection rate. But why not aspire for
more? "For any endoscopy doctors who are interested in high-quality
colonoscopy, which should be all of us, that target ADR should be clos-
er to 35%," says Dr. Keswani. "That 25% is sometimes called the 'base-
ment' ADR and that 35% the 'aspirational' ADR. That's where we
should all strive to be."
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